Racial Disparity in Access High Quality Cardiac Surgeons

描述(由申请人提供)：在获得高质量心脏外科医生方面，老年人之间存在种族差异。获得医疗保健服务方面的种族差异是美国医疗保健系统长期存在的一个特征，尽管人们对此缺乏充分的了解。少数族裔获得服务的机会不足，因为这导致健康状况不佳和健康状况不佳，已成为我国国家卫生政策议程的重要组成部分。少数族裔已被证明不太可能接受心脏手术。即使当他们获得手术机会时，他们仍然处于不利地位，因为与白人相比，他们获得的外科医生的风险调整死亡率(RAMR)更高。 这些问题对老年人特别重要，因为心脏病是老年人的主要疾病之一，是导致死亡的主要原因，超过50%的CABG手术是在65岁及以上的人身上进行的。这项拟议的研究旨在测试关于导致观察到的高质量心脏外科医生机会差异的因素的具体假设。它将测试与三个转诊决策焦点相关的假设：患者、转诊医生和管理型医疗组织(MCO)。研究人群将包括所有接受CABG手术的医疗保险患者、所有心脏外科医生和纽约的医院。Medicare CABG患者将接受调查，了解他们使用RAMR信息的情况，以及他们与转诊医生的遭遇。手术前医疗护理遭遇的医疗保险索赔将用于分析转诊模式。将使用NYS SPARCS数据和MCO信息，以及一个独特的数据集，其中包含MCO与医院和心脏外科医生的合同模式信息，以研究MCO对准入方面的种族差异的影响。将使用统计多元回归技术来分析数据。从这个项目中获得的知识对于制定有针对性的计划至关重要，这些计划可以成功地解决老年少数族裔在获得高质量心脏护理方面的差距。

DESCRIPTION (provided by applicant): Racial disparities in access to high quality cardiac surgeons among the elderly Racial disparities in access to health care services is a well documented, if poorly understood, persistent characteristic of the American health care system. Inadequate access to services by racial minorities, as it leads to poor health outcomes and poor health, has become an important part of our national health policy agenda. Racial minorities have been shown to be less likely to receive cardiac surgery. Even when they gain access to surgery, they are still disadvantaged because they access surgeons with higher risk-adjusted mortality rates (RAMR), compared to whites. These issues are of particular importance to the elderly population, as heart disease is one of the major morbidities in this population, it is the leading cause of death and over 50% of CABG surgeries are performed on individuals aged 65 and older. The proposed study is designed to test specific hypotheses about the factors contributing to the observed disparities in access to high quality cardiac surgeons. It will test hypotheses related to three referral decisions foci: the patient, the referring physician and the managed care organization (MCO). The population studied will include all Medicare patients undergoing CABG surgery, all cardiac surgeons and hospitals in NYS. Medicare CABG patients will be surveyed about their use of RAMR information and their encounter with the referring physician. Medicare claims for medical care encounters prior to the surgery will be used to analyze referral patterns. NYS SPARCS data and MCO information, as well as a unique data set with information about contracting patterns of MCOs with hospitals and cardiac surgeons, will be used to study the effect of MCOs on racial disparities in access. Statistical multivariate regression techniques will be used to analyze the data. The knowledge gained in this project is essential for development of targeted programs that could successfully address the disparity in access to high quality cardiac care among elderly racial minorities.