Within-Physician Differences in Patient Sharing Between Primary Care Physicians and Cardiologists Who Treat White and Black Patients With Heart Disease.
Within-Physician Differences in Patient Sharing Between Primary Care Physicians and Cardiologists Who Treat White and Black Patients With Heart Disease.
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DOI：
10.1161/jaha.123.030653
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发表时间：
2023-11-20
影响因子：
5.4
通讯作者：
Popescu, Ioana
中科院分区：
文献类型：
--
作者：
Matthews, Luke J.;Damberg, Cheryl L.;Zhang, Shiyuan;Escarce, Jose J.;Gibson, C. Ben;Schuler, Megan;Popescu, Ioana
心脏病治疗中的黑白差异可能归因于医生转诊网络的差异。我们绘制了医疗保险患者的医生网络，并检查了初级保健医生和心脏病专家之间患者共享方面的医生内部黑白差异。使用 2016 年至 2017 年的医疗保险按服务收费文件，我们确定了一组患有心脏病的黑人和白人患者以及治疗他们的初级保健医生和心脏病专家。为了确保医生内部比较的稳健性，我们将样本限制在区域医疗保健市场（即医院转诊区域），其中至少有 10 名医生共用 ≥3 名黑人和白人患者。我们使用声明构建了 2 个针对特定种族的医生网络度量：程度（初级保健医生与之共享患者的心脏病专家数量）和传递性（网络紧密度）。根据医生小组规模的黑白差异调整测量值，并针对所有环境（医院和办公室）以及仅针对办公室环境进行计算。在 306 个美国医院转诊地区中，分别有 226 个和 145 个符合所有环境和办公室环境分析的研究标准。黑人患者总体上有更多的心脏病就诊次数（6.9 比 6.6；P < 0.001）和独特的心脏病专家（3.0 比 2.6；P < 0.001），但办公室就诊次数较少（31.7% 比 41.1%；P < 0.001）。与白人患者相比，初级保健医生与更多的心脏病专家共同诊治黑人患者（所有设置的平均差异度为 23.4，办公室分析为 3.6；两者 P<0.001）。除办公室环境外，黑人患者共享网络在所有环境中的连接都不太紧密（所有环境的平均微分传递性为-0.2 [P<0.001]，办公室分析的平均微分传递性接近 0 [P=0.74]）。医生内部在患者共享方面存在黑人和白人差异，并且可能导致心脏护理方面的差异。
Black‐White disparities in heart disease treatment may be attributable to differences in physician referral networks. We mapped physician networks for Medicare patients and examined within‐physician Black‐White differences in patient sharing between primary care physicians and cardiologists. Using Medicare fee‐for‐service files for 2016 to 2017, we identified a cohort of Black and White patients with heart disease and the primary care physicians and cardiologists treating them. To ensure the robustness of within‐physician comparisons, we restricted the sample to regional health care markets (ie, hospital referral regions) with at least 10 physicians sharing ≥3 Black and White patients. We used claims to construct 2 race‐specific physician network measures: degree (number of cardiologists with whom a primary care physician shares patients) and transitivity (network tightness). Measures were adjusted for Black‐White differences in physician panel size and calculated for all settings (hospital and office) and for office settings only. Of 306 US hospital referral regions, 226 and 145 met study criteria for all settings and office setting analyses, respectively. Black patients had more cardiology encounters overall (6.9 versus 6.6; P<0.001) and with unique cardiologists (3.0 versus 2.6; P<0.001), but fewer office encounters (31.7% versus 41.1%; P<0.001). Primary care physicians shared Black patients with more cardiologists than White patients (mean differential degree 23.4 for all settings and 3.6 for office analyses; P<0.001 for both). Black patient‐sharing networks were less tightly connected in all but office settings (mean differential transitivity −0.2 for all settings [P<0.001] and near 0 for office analyses [P=0.74]). Within‐physician Black‐White differences in patient sharing exist and may contribute to disparities in cardiac care.