John M Hollingsworth1, Xianshi Yu2,3, Akbar K Waljee4,5,2,6, Brahmajee K Nallamothu7,5,2,6, Phyllis L Yan1, Hyesun Yoo2,3, Dana A Telem8, Ekow N Yankah9, Ji Zhu2,3. 1. Department of Urology (J.M.H., P.L.Y.), University of Michigan Medical School, Ann Arbor. 2. Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor (X.Y., H.Y., J.Z., A.K.W., B.K.N.). 3. Department of Statistics, University of Michigan College of Literature, Science, and Arts, Ann Arbor (X.Y., H.Y., J.Z.). 4. Division of Gastroenterology and Hepatology (A.K.W.), University of Michigan Medical School, Ann Arbor. 5. Department of Internal Medicine (A.K.W., B.K.N.), University of Michigan Medical School, Ann Arbor. 6. VA Center for Clinical Management Research, VA Ann Arbor Health Care System, MI (A.K.W., B.K.N.). 7. and Division of Cardiology (B.K.N.), University of Michigan Medical School, Ann Arbor. 8. Department of Surgery (D.A.T.), University of Michigan Medical School, Ann Arbor. 9. Cardozo Law School, New York, NY (E.N.Y.).
Abstract
BACKGROUND: Studies have shown that Black patients die more frequently following coronary artery bypass grafting than their White counterparts for reasons not fully explained by disease severity or comorbidity. To examine whether provider care team segregation within hospitals contributes to this inequity, we analyzed national Medicare data. METHODS: Using national Medicare data, we identified beneficiaries who underwent coronary artery bypass grafting at hospitals where this procedure was performed on at least 10 Black and 10 White patients between 2008 and 2014 (n=12 646). After determining the providers who participated in their perioperative care, we examined the extent to which Black and White patients were cared for by unique networks of provider care teams within the same hospital. We then evaluated whether a lack of overlap in composition of the provider care teams treating Black versus White patients (ie, high segregation) was associated with higher 90-day operative mortality among Black patients. RESULTS: The median level of provider care team segregation was high (0.89) but varied across hospitals (interquartile range, 0.85-0.90). On multivariable analysis, after controlling for patient-, hospital-, and community-level differences, mortality rates for White patients were comparable at hospitals with high and low levels of provider care segregation (5.4% [95% CI, 4.7%-6.1%] versus 5.8% [95% CI, 4.7%-7.0%], respectively; P=0.601), while Black patients treated at high-segregation hospitals had significantly higher mortality than those treated at low-segregation hospitals (8.3% [95% CI, 5.4%-12.4%] versus 3.3% [95% CI, 2.0%-5.4%], respectively; P=0.017). The difference in mortality rates for Black and White patients treated at low-segregation hospitals was nonsignificant (-2.5%; P=0.098). CONCLUSIONS: Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
BACKGROUND: Studies have shown that Black patients die more frequently following coronary artery bypass grafting than their White counterparts for reasons not fully explained by disease severity or comorbidity. To examine whether provider care team segregation within hospitals contributes to this inequity, we analyzed national Medicare data. METHODS: Using national Medicare data, we identified beneficiaries who underwent coronary artery bypass grafting at hospitals where this procedure was performed on at least 10 Black and 10 White patients between 2008 and 2014 (n=12 646). After determining the providers who participated in their perioperative care, we examined the extent to which Black and White patients were cared for by unique networks of provider care teams within the same hospital. We then evaluated whether a lack of overlap in composition of the provider care teams treating Black versus White patients (ie, high segregation) was associated with higher 90-day operative mortality among Black patients. RESULTS: The median level of provider care team segregation was high (0.89) but varied across hospitals (interquartile range, 0.85-0.90). On multivariable analysis, after controlling for patient-, hospital-, and community-level differences, mortality rates for White patients were comparable at hospitals with high and low levels of provider care segregation (5.4% [95% CI, 4.7%-6.1%] versus 5.8% [95% CI, 4.7%-7.0%], respectively; P=0.601), while Black patients treated at high-segregation hospitals had significantly higher mortality than those treated at low-segregation hospitals (8.3% [95% CI, 5.4%-12.4%] versus 3.3% [95% CI, 2.0%-5.4%], respectively; P=0.017). The difference in mortality rates for Black and White patients treated at low-segregation hospitals was nonsignificant (-2.5%; P=0.098). CONCLUSIONS: Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
Authors: Jordan Everson; Russell J Funk; Samuel R Kaufman; Jason Owen-Smith; Brahmajee K Nallamothu; Francis D Pagani; John M Hollingsworth Journal: Health Serv Res Date: 2017-05-04 Impact factor: 3.402
Authors: A V Diez Roux; S S Merkin; D Arnett; L Chambless; M Massing; F J Nieto; P Sorlie; M Szklo; H A Tyroler; R L Watson Journal: N Engl J Med Date: 2001-07-12 Impact factor: 91.245
Authors: Michael L Barnett; Bruce E Landon; A James O'Malley; Nancy L Keating; Nicholas A Christakis Journal: Health Serv Res Date: 2011-04-26 Impact factor: 3.402
Authors: Hassan M K Ghomrawi; Russell J Funk; Michael L Parks; Jason Owen-Smith; John M Hollingsworth Journal: PLoS One Date: 2018-02-20 Impact factor: 3.240