Regulatory Reforn and Angiography Disparties

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DESCRIPTION (provided by applicant): Beginning in 1996, New Jersey embarked on hospital regulatory reforms that addressed, among other goals, the long-standing problem of racial and ethnic disparities in use of cardiac angiography (CA). These reforms led to a doubling in the number of hospitals performing CA as well as state-monitoring of minority outreach and access activities for CA services at each hospital. This proposal builds on AHRQ-funded pilot studies to examine the effectiveness of this innovative policy. Specific aims are to: (1) determine whether the disparity between black and white CA utilization declined following implementation of NJ policies intended to expand access for minority patients, (2) evaluate how local health system characteristics may influence CA disparities and the pathways through which the NJ policy may have reduced these disparities; and (3) identify promising strategies for reducing CA disparities. Hispanic-white CA disparities will also be investigated. Quantitative modeling and qualitative analyses will be blended to evaluate CA disparity trends from 1993-2003 in contrast to trends in a non-reform state. Primary outcome measures are the white-black difference in age-sex adjusted CA rates in small areas and the volume and share of CA utilization by black patients at NJ hospitals that provided CA throughout the study period. Regression methods will be used to adjust for market area demographics and other factors. Hypotheses about the effects of changes in CA capacity and hospital competition will be tested. CA facilities that demonstrate higher-than-expected levels of service to black patients, based on regression models, will be selected for intensive case studies along with a set of matched comparison facilities that are not high performing. The case studies will be focused on the market areas of the selected facilities, and will include documentary review and semi-structured interviews of officials from the selected CA facilities, referring hospitals, community health centers and other players in the case markets. Research findings will be translated to the practice and policy community in the form of "best practices" and through feedback of hospital-specific CA disparity performance measures.