Association between clinician team segregation, receipt of cardiovascular care and outcomes in valvular heart diseases.

Autor: Bolakale-Rufai IK; Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA., Knapp SM; Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA.; Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA., Bisono JQ; Department of Internal Medicine, Indiana University, Indianapolis, Indiana, USA.; Indiana University Health, Indianapolis, Indiana, USA., Johnson A; Department of Internal Medicine, Indiana University, Indianapolis, Indiana, USA.; Indiana University Health, Indianapolis, Indiana, USA., Moore W; Sarver Heart Center Minority Outreach Program, University of Arizona, Tucson, Arizona, USA., Yankah E; Department of Law and Philosophy, University of Michigan, Ann Arbor, Michigan, USA., Yee R; Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA., Trabue D; Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA., Nallamothu B; Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, Michigan, USA., Hollingsworth JM; Quality Department, Endeavor Health NorthShore Hospitals, Evanston, Illinois, USA., Watty S; Department of Internal Medicine, Indiana University, Indianapolis, Indiana, USA., Williamson F; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA., Pool N; School of Nursing, University of Northern Colorado, Greeley, Colorado, USA., Hebdon M; School of Nursing, University of Texas at Austin, Austin, Texas, USA., Ezema N; Division of Clinical Trials Operations Management, Nex Gen Research, Dayton, Ohio, USA., Capers Q; Department of Medicine, Howard University College of Medicine, Washington, D.C., USA., Blount C; Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA., Kimbrough N; Sisters Together Centers of Wellness for Urban Women, Indianapolis, Indiana, USA., Johnson D; Indiana University Health, Indianapolis, Indiana, USA., Evans J; Indiana University Health, Indianapolis, Indiana, USA., Foree B; Indiana University Health, Indianapolis, Indiana, USA., Holman A; Division of Chaplaincy Education, IU Health System, Indianapolis, Indiana, USA., Lightbourne K; Division of Community Networks collaborations for the East Region, Indianapolis, Indiana, USA., Brown D; Department of Otolaryngology-Head and Neck Surgery and Pediatric Otolaryngology, Michigan Medicine, Ann Arbor, Michigan, USA., Edmonds BT; Indiana University Health, Indianapolis, Indiana, USA.; Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana, USA., Breathett K; Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA.; Indiana University Health, Indianapolis, Indiana, USA.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2024 Oct 17. Date of Electronic Publication: 2024 Oct 17.
DOI: 10.1002/ehf2.15078
Abstrakt: Aims: Racial disparities exist in clinical outcomes for valvular heart disease (VHD). It is unknown whether clinician segregation contributes to these disparities. Among an adequately insured population, we evaluated the relationship between clinician segregation in a hospital and receipt of care by a cardiologist according to patient race. We also evaluated the association between clinician segregation, race and care by a cardiologist on 30-day readmission and 1-year survival.
Methods and Results: Using Optum's Clinformatics® Data Mart Database (CDM, US commercial and Medicare beneficiaries) from 2010 to 2018, we identified patients with a primary diagnosis of VHD. Hospitals were categorized into low, medium and high segregation groups (SG), according to clinician segregation index (SI). SI can range from 0-1 (0: the ratio of Black to White patients is the same for all clinicians; 1: each clinician treats only Black or only White patients). Outcomes were analysed using generalized linear mixed effect models. Among 8649 patients [median age 75 (67-82), 45.4% female, 16.1% Black, 83.9% White], odds of care from a cardiologist did not vary across race for all SGs [Low SG adjusted odds ratio (aOR): 0.79 (95% CI: 0.58-1.08), P = 0.14; Medium SG aOR: 0.86 (95% CI: 0.60-1.25), P = 0.43; High SG aOR: 1.07 (95% CI: 0.68-1.69), P = 0.76]. Among those that received care from a cardiologist, there was no difference in the 30-day readmission between Black and White patients across SGs [Low SG aOR: 1.05 (95% CI: 0.83-1.31), P = 0.70; Medium SG aOR: 1.22 (95% CI: 0.92-1.61), P = 0.17; High SG aOR: 0.81 (95% CI: 0.57-1.17), P = 0.27]. Among patients that did not receive care from a cardiologist, Black patients in low SG had higher odds of 30-day readmission compared to White patients [aOR: 2.74 (95%CI:1.38-5.43), P < 0.01]. Odds of 1-year survival were similar across race for all SG irrespective of receipt of care from a cardiologist [seen by a cardiologist: Low SG aOR: 1.13 (95% CI: 0.86-1.48), P = 0.38; Medium SG aOR: 0.83 (95% CI: 0.59-1.17), P = 0.29; High SG aOR: 1.01 (95% CI: 0.66-1.52), P = 0.98; not seen by a cardiologist: Low SG aOR: 0.56 (95% CI: 0.23-1.34), P = 0.19; Medium SG aOR: 0.81 (95% CI: 0.28-2.37), P = 0.70; High SG aOR: 0.63 (95% CI: 0.23-1.74), P = 0.37].
Conclusions: Among an insured population, race was not associated with care by a cardiologist for VHD or survival. Black patients not seen by cardiologists had higher odds of 30-day readmission in low clinician SG.
(© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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