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Differences in specialist consultations for cardiovascular disease by race, ethnicity, gender, insurance status, and
Nakela L Cook1, John Z Ayanian, E John Orav
1National Heart, Lung, and Blood Institute, Rockledge II, Bethesda, MD 20892, USA. cookn2@nhlbi.nih.gov
Circulation
|April 29, 2009
Summary
Cardiology consultations improve care quality for heart disease patients. However, women and those in community health centers face access barriers, highlighting disparities in cardiology access and quality of care.
Area of Science:
- Cardiology
- Health Services Research
- Health Equity
Background:
- Cardiology consultations can enhance ambulatory care quality and reduce health disparities for heart disease patients.
- Assessing cardiology consultation utilization and quality across diverse patient demographics is crucial for identifying inequities.
Purpose of the Study:
- To evaluate the utilization of cardiology consultations among patients with coronary artery disease (CAD) or congestive heart failure (CHF).
- To examine disparities in cardiology consultation access and quality based on race/ethnicity, gender, insurance status, and care site.
- To determine the association between cardiology consultation and the quality of ambulatory care.
Main Methods:
- Retrospective cohort study of 9761 adult patients with CAD or CHF from 2000-2005.
- Analysis of electronic health records to assess cardiology consultation rates and follow-up frequency.
- Multivariate analyses to identify factors associated with consultation access and quality.
Main Results:
- Over 79% of CAD and 90% of CHF patients received a cardiology consultation.
- Women and patients at community health centers had significantly lower consultation rates compared to men and those at hospital-based practices, respectively.
- Consultation was linked to improved care processes, particularly narrowing the quality gap for women.
Conclusions:
- Women and patients receiving care at community health centers experience reduced access to cardiologists for CAD and CHF.
- Cardiology consultation is associated with superior quality of care and helps mitigate gender-based disparities in healthcare quality.
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