Caillier James Gerard, Brown Sandra C, Parsons Sharon, Ardoin Phillip J, Cruise Peter
Bowie State University, MLK Room 323, 14000 Jericho Park Rd., Bowie, MD 20715 USA.
Ethn Dis. 2007 Summer;17(3):461-6.
The purpose of this study was to examine physician bias when patients present with cardiovascular disease in a teaching hospital that treats a majority of African American patients. Physician bias was deemed to occur when cardiovascular disease patients did not receive an invasive procedure when needed.
The hospital in the study was a teaching facility in southeastern Louisiana. We conducted a longitudinal retrospective review of 177 medical records from patients with cardiovascular disease. Patient charts were examined using specific indicators (type of pain, lab work, blood pressure, and x-ray tests) from the Framingham study (1996) to determine whether patients met the criteria for eligibility of invasive procedures, such as percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) and if so, whether they were referred accordingly. Next, these charts were used to obtain confounders (race, sex, income, age, disease severity, and diagnoses) from each patient. Finally, a logistic regression analysis was used to determine the effect of these confounders on a patient being referred by a physician.
The model failed to find a statistically significant disparity between physician referrals for African Americans and Caucasians when cardiovascular disease patients met specific criteria. Therefore, physician referral disparities did not exist among this study population. This occurred despite the fact that the study controlled for primary diagnoses, disease severity, age, income, sex, and race.
This research concludes that physicians' referral patterns for cardiac procedures were similar for both African Americans and Caucasians. Moreover, this research suggests that referral disparities may not exist at teaching hospitals that serve a majority of African American patients. Future studies should delve deeper into physician/patient interaction at these institutions to understand what they do to reduce disparities in the hope of implementing their methods at other hospitals.
本研究旨在调查在一家以收治大多数非裔美国患者为主的教学医院中，当患者患有心血管疾病时医生的偏见情况。当心血管疾病患者在需要时未接受侵入性治疗时，即认为存在医生偏见。
研究中的医院是路易斯安那州东南部的一家教学机构。我们对177例心血管疾病患者的病历进行了纵向回顾性研究。使用弗雷明汉研究（1996年）的特定指标（疼痛类型、实验室检查、血压和X光检查）检查患者病历，以确定患者是否符合侵入性治疗（如经皮冠状动脉腔内血管成形术（PTCA）或冠状动脉搭桥术（CABG））的资格标准，若符合，是否得到相应转诊。接下来，利用这些病历获取每位患者的混杂因素（种族、性别、收入、年龄、疾病严重程度和诊断结果）。最后，采用逻辑回归分析来确定这些混杂因素对医生转诊患者的影响。
当心血管疾病患者符合特定标准时，该模型未发现非裔美国人和白种人在医生转诊方面存在统计学上的显著差异。因此，本研究人群中不存在医生转诊差异。尽管该研究对主要诊断、疾病严重程度、年龄、收入、性别和种族进行了控制，但仍出现了这种情况。
本研究得出结论，非裔美国人和白种人在心脏手术方面的医生转诊模式相似。此外，本研究表明，在以收治大多数非裔美国患者为主的教学医院中可能不存在转诊差异。未来的研究应更深入地探究这些机构中医患之间的互动，以了解他们为减少差异所采取的措施，希望能在其他医院实施这些方法。
