Gibson C Ben, Damberg Cheryl L, Escarce Jose J, Zhang Shiyuan, Schuler Megan S, Matthews Luke J, Popescu Ioana
RAND Corporation, Santa Monica, CA (C.B.G., C.L.D., S.Z., M.S., L.J.M., I.P.).
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California at Los Angeles, CA (J.J.E., I.P.).
Circ Cardiovasc Qual Outcomes. 2025 Jan;18(1):e010778. doi: 10.1161/CIRCOUTCOMES.123.010778. Epub 2024 Dec 27.
Differences in the quality of hospitals where Black and White patients receive coronary artery bypass grafting (CABG) surgery have been documented. We examined the contributions of physician networks to the gap.
This was a cross-sectional study of all Medicare fee-for-service Black and White patients undergoing elective CABG during 2017 to 2019; the primary care physicians and cardiologists treating them for 12 months before surgery (the patients' physician network); and CABG-performing hospitals within 100 miles of each patient. We measured the strength of ties between treating physicians and hospitals as the number of shared prior CABG patients (24 months before surgery). Conditional logit models assessed the relationship between race, prior physician-hospital ties, and receiving CABG at hospitals with minimum versus the median-above-minimum mortality difference, while accounting for home-to-hospital distances.
The study included 76 376 patients; 5.1% were Blackpatients. Black and White patients were admitted to similar mortality hospitals (3.1% versus 3.1%; =0.07), but Black patients lived closer to lower-mortality hospitals than White patients (mean hospital mortality within median travel distance, 2.5% versus 2.7%; <0.001). Black patients were treated less often at the lowest-mortality hospitals overall and within the median travel distance (10.5% versus 13.9% and 37.4% versus 45.1%; <0.001 for both). In conditional logit models, the Black-White risk ratio of using hospitals with median versus lowest mortality was 1.02 ([95% CI, 0.98-1.06]; =0.18) in models including only race and hospital mortality; 1.07 ([95% CI, 1.01-1.13]; <0.001) in models adding home-to-hospital distances; and 1.06 ([95% CI, 0.96-1.16]; =0.11) in models also accounting for physician-hospital ties.
Despite the improvement of previously described disparities in the quality of hospitals treating Black and White patients, Black patients remain less likely to undergo CABG at their lowest available mortality hospitals, possibly due to suboptimal physician referrals.
有文献记载，黑人和白人患者接受冠状动脉搭桥术（CABG）的医院质量存在差异。我们研究了医生网络对这一差距的影响。
这是一项横断面研究，研究对象为2017年至2019年期间所有接受择期CABG的医疗保险按服务收费的黑人和白人患者；在手术前12个月治疗他们的初级保健医生和心脏病专家（患者的医生网络）；以及每位患者100英里范围内进行CABG手术的医院。我们将治疗医生和医院之间的联系强度衡量为共同的既往CABG患者数量（手术前24个月）。条件logit模型评估了种族、既往医生与医院的联系，以及在死亡率最低与中位数以上最低差异的医院接受CABG之间的关系，同时考虑了家到医院的距离。
该研究纳入了76376名患者；5.1%为黑人患者。黑人和白人患者入住死亡率相似的医院（3.1%对3.1%；P = 0.07），但黑人患者比白人患者住得离死亡率较低的医院更近（中位出行距离内的平均医院死亡率，2.5%对2.7%；P < 0.001）。总体而言，以及在中位出行距离内，黑人患者在死亡率最低的医院接受治疗的频率较低（10.5%对13.9%，37.4%对45.1%；两者P均< 0.001）。在条件logit模型中，在仅包括种族和医院死亡率的模型中，使用死亡率中位数与最低的医院的黑人与白人风险比为1.02（[95%CI，0.98 - 1.06]；P = 0.18）；在增加家到医院距离的模型中为1.07（[95%CI，1.01 - 1.13]；P < 0.
