van Ryn Michelle, Burgess Diana, Malat Jennifer, Griffin Joan
Department of Family Practice and Community Health, University of Minnesota, Room 225 Dinnaken Building, 925 Delaware Street SE, Minneapolis, MN 55414, USA.
Am J Public Health. 2006 Feb;96(2):351-7. doi: 10.2105/AJPH.2004.041806. Epub 2005 Dec 27.
A growing body of evidence suggests that provider decisionmaking contributes to racial/ethnic disparities in care. We examined the factors mediating the relationship between patient race/ethnicity and provider recommendations for coronary artery bypass graft surgery.
Analyses were conducted with a data set that included medical record, angiogram, and provider survey data on postangiogram encounters with patients who were categorized as appropriate candidates for coronary artery bypass graft surgery.
Race significantly influenced physician recommendations among male, but not female, patients. Physicians' perceptions of patients' education and physical activity preferences were significant predictors of their recommendations, independent of clinical factors, appropriateness, payer, and physician characteristics. Furthermore, these variables mediated the effects of patient race on provider recommendations.
Our findings point to the importance of research and intervention strategies addressing the ways in which providers' beliefs about patients mediate disparities in treatment. In addition, they highlight the need for discourse and consensus development on the role of social factors in clinical decisionmaking.
越来越多的证据表明，医疗服务提供者的决策导致了医疗保健中的种族/民族差异。我们研究了患者种族/民族与医疗服务提供者对冠状动脉搭桥手术建议之间关系的中介因素。
对一个数据集进行分析，该数据集包括病历、血管造影以及医疗服务提供者对血管造影后与被归类为冠状动脉搭桥手术合适候选人的患者会诊情况的调查数据。
种族对男性患者而非女性患者的医生建议有显著影响。医生对患者教育程度和身体活动偏好的认知是其建议的重要预测因素，独立于临床因素、适宜性、付款人及医生特征。此外，这些变量介导了患者种族对医疗服务提供者建议的影响。
我们的研究结果指出了研究和干预策略的重要性，这些策略应针对医疗服务提供者对患者的信念如何介导治疗差异的方式。此外，它们凸显了就社会因素在临床决策中的作用展开讨论并达成共识的必要性。
