Department of Urology (J.M.H., P.L.Y.), University of Michigan Medical School, Ann Arbor.
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.).
Circ Cardiovasc Qual Outcomes. 2021 May;14(5):e007778. doi: 10.1161/CIRCOUTCOMES.120.007778. Epub 2021 Apr 30.
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.
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.
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; =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; =0.017). The difference in mortality rates for Black and White patients treated at low-segregation hospitals was nonsignificant (-2.5%; =0.098).
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.
研究表明，黑人患者在接受冠状动脉旁路移植手术后的死亡率高于白人患者，其原因尚未完全解释清楚，不能完全用疾病严重程度或合并症来解释。为了研究医院内的医疗服务团队隔离是否导致了这种不平等，我们分析了全国医疗保险数据。
我们利用全国医疗保险数据，确定了 2008 年至 2014 年间在至少有 10 名黑人患者和 10 名白人患者接受冠状动脉旁路移植术的医院接受手术的受益人（n=12646）。在确定参与他们围手术期护理的提供者后，我们检查了黑人患者和白人患者在同一医院内由独特的提供者护理团队网络进行护理的程度。然后，我们评估了治疗黑人患者和白人患者的提供者护理团队组成缺乏重叠（即高隔离）是否与黑人患者 90 天手术死亡率升高有关。
提供者护理团队隔离的中位数水平较高（0.89），但在医院之间存在差异（四分位距，0.85-0.90）。在多变量分析中，在控制了患者、医院和社区层面的差异后，白人患者在提供者护理隔离程度高和低的医院的死亡率相似（分别为 5.4%[95%置信区间，4.7%-6.1%]和 5.8%[95%置信区间，4.7%-7.0%]；=0.601），而在高隔离医院接受治疗的黑人患者的死亡率明显高于在低隔离医院接受治疗的黑人患者（分别为 8.3%[95%置信区间，5.4%-12.4%]和 3.3%[95%置信区间，2.0%-5.4%]；=0.017）。在低隔离医院接受治疗的黑人和白人患者的死亡率差异无统计学意义（-2.5%；=0.098）。
在提供者护理团队隔离程度较高的医院接受冠状动脉旁路移植术的黑人患者，手术后死亡的频率高于在提供者护理团队隔离程度较低的医院接受治疗的黑人患者。
