Referral Networks, Racial Inequity, and Hospital Quality for Open Heart Surgery

Area of Science:

• Health Services Research
• Cardiovascular Surgery
• Health Equity

Background:

• Disparities in hospital quality for Black and White patients undergoing coronary artery bypass grafting (CABG) are documented.
• Physician networks may play a role in these observed quality gaps.

Purpose of the Study:

• To examine how physician networks contribute to racial disparities in CABG surgery quality.
• To investigate if patient race influences the likelihood of receiving CABG at higher-quality hospitals.

Main Methods:

• Cross-sectional study of Medicare fee-for-service patients undergoing elective CABG (2017-2019).
• Analysis included patient race, their treating physicians, and CABG hospitals within 100 miles.
• Physician-hospital ties measured by shared prior CABG patients; conditional logit models used.

Main Results:

• Black patients (5.1%) were admitted to hospitals with similar mortality rates as White patients.
• Black patients lived closer to lower-mortality hospitals but were less often treated at the lowest-mortality facilities.
• After accounting for distance and physician ties, Black patients were not significantly more or less likely to use median-mortality hospitals compared to lowest-mortality hospitals.

Conclusions:

• While hospital quality disparities have improved, Black patients are still less likely to have CABG at their lowest-mortality hospitals.
• Suboptimal physician referrals may contribute to Black patients not being directed to the best available cardiac surgery centers.