Physician Networks and the Racial Gap in Hospital Quality of Care for Coronary Heart Disease

项目总结/摘要 在冠心病（CHD）的治疗中，白人和黑人的差异部分是由于 黑人和白色病人使用的医院质量的差异，研究表明， 非地理因素发挥了重要作用。这些非地理因素可能包括 照顾黑人和白色CHD患者的医生存在差异。为支持这一 假设，研究表明，黑人病人的护理集中在一个小的 医生人数，他们报告说，获得专家和医院的机会较少， 专业隔离。此外，研究表明，黑人和白色患者可能 即使由同一名医生或医生转诊，也会受到不同的治疗 网络.在治疗患有冠心病的黑人和白色老年人的医生之间是否存在差异 造成医院质量种族差距的原因仍然不明。 该提案的总体目标是识别和描述医生和网络 治疗黑人和白色老年冠心病，并调查医生和网络因素， 与高质量医院使用中的种族差距相关， 社会网络和计量经济学数据分析，以及针对医生的调查， 黑人和白色病人。这项研究将包括35个大都市地区的老年人， 和白色人群，包括两种心脏疾病：急性心肌梗死（AMI）， 紧急情况通常需要运送到最近的医院，冠状动脉 旁路移植术（CABG），一种涉及专科转诊的常见择期手术。 研究目标将依次构建城市级网络;确定医生的子网络 在可能一起工作的较大的都市区域内（即，转诊网络）;措施 网络隔离;测量可能相关的医师和子网络特征 医院访问和转诊过程;调查这些医生的样本 网络，以了解自我报告的困难与转介过程;估计回归 评估医生及其测量和自我报告特征的影响的模型 在高质量的冠心病医院使用的白黑差距;并采用模拟评估 通过修改相关特征实现的潜在政策效应。 这项研究将解决重要的，以前没有回答的问题，医生转诊 在美国不同的大都市地区，为患有冠心病的黑人和白色老年人提供网络。是网络 网络隔离与居住隔离的相关程度如何？ 患有冠心病的黑人和白色老年人是否使用医生和子网络的特征 (e.g.,医师资格和心脏病专家在子网络内的中心地位）不同 是否会影响高质量医院的使用？本研究将探讨这些重要的 研究和政策问题。

Project Summary/ Abstract White-black disparities in the treatment of coronary heart disease (CHD) are due in part to differences in the quality of hospitals used by black and white patients, and studies suggest that non-geographic factors play an important role. Such non-geographic factors likely include differences in the physicians caring for black and white patients with CHD. In support of this hypothesis, research has shown that the care of black patients is concentrated within a small number of physicians, who report lower access to specialists and hospitals, and may be more isolated professionally. In addition, research has shown that black and white patients may be treated differently even when they are cared for by the same physicians or physician referral networks. Whether differences among physicians caring for black and white seniors with CHD contribute to the racial gap in hospital quality remains unknown. The overarching goal of this proposal is to identify and characterize physicians and networks treating black and white seniors with CHD, and to investigate the physician and network factors associated with the racial gap in high quality hospital use using a combination of state of the art social network and econometric data analyses, and surveys directed at physicians caring for black and white patients. The study will include seniors in 35 metro areas with sizable black and white populations and include two cardiac conditions: acute myocardial infarction (AMI), an emergency condition typically requiring transport to the nearest hospital, and coronary artery bypass grafting surgery (CABG), a frequently elective procedure involving specialty referral. Study aims will sequentially construct metro-level networks; identify sub-networks of physicians within the larger metro area that are likely to work together (i.e., referral networks); measure network segregation; measure physician and sub-network characteristics that may be relevant for hospital access and the referral process; survey a sample of physicians within these networks to understand self-reported difficulties with the referral process; estimate regression models to assess the effects of physicians and their measured and self-reported characteristics on the white-black gap in high quality hospital use for CHD; and employ simulations to assess potential policy effects achieved by modifying relevant characteristics. The study will address important, previously unanswered questions about physician referral networks for black and white seniors with CHD in diverse US metro areas. Are networks segregated, and to what degree is network segregation correlated with residential segregation? Are characteristics of physicians and sub-networks used by black and white seniors with CHD (e.g., physician qualifications and the centrality of cardiologists within a sub-network) different and do they affect the use of high quality hospitals? The study will address these important research and policy questions.