Racial Disparities in Outcomes After Cardiac Surgery: the Role of Hospital Quality

Current Cardiology Reports

Volumn 17, Issue 5, 2015, Pages

  Khera, Rohan ^a   Vaughan Sarrazin, Mary ^a,b,c   Rosenthal, Gary E ^c   Girotra, Saket ^c  

^a UNIVERSITY OF IOWA HOSPITALS AND CLINICS   (United States)

^b VETERANS AFFAIRS MEDICAL CENTER   (United States)

^c UNIVERSITY OF IOWA   (United States)

Author keywords

CABG; Coronary artery bypass grafting; Health disparities; Hospital outcomes; Hospital quality; Quality improvement; Racial disparity

Indexed keywords

BLACK PERSON; CAUCASIAN; COMORBIDITY; CULTURAL FACTOR; GENETIC DIFFERENCE; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH STATUS; HEART SURGERY; HIGH RISK PATIENT; HOSPITAL CARE; HUMAN; MORBIDITY; RACE DIFFERENCE; REVIEW; SOCIOECONOMICS; SURGICAL MORTALITY; TREATMENT OUTCOME; ETHNOLOGY; HEALTH DISPARITY; MORTALITY; SOCIAL ASPECTS AND RELATED PHENOMENA; STANDARDS; UNITED STATES;

AFRICAN CONTINENTAL ANCESTRY GROUP; CARDIAC SURGICAL PROCEDURES; COMORBIDITY; EUROPEAN CONTINENTAL ANCESTRY GROUP; HEALTH POLICY; HEALTH STATUS DISPARITIES; HOSPITAL MORTALITY; HUMANS; QUALITY OF HEALTH CARE; SOCIOLOGICAL FACTORS; TREATMENT OUTCOME; UNITED STATES;

EID: 84928345812     PISSN: 15233782     EISSN: 15343170     Source Type: Journal    
DOI: 10.1007/s11886-015-0587-7     Document Type: Review

References (70)

1. Centers for Disease Control and Prevention. FastStats - Inpatient surgery. http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm, accessed October 4, 2014.
2. Mehta NJ, Khan IA. Cardiology’s 10 greatest discoveries of the 20th century. Texas Heart Inst J Texas Heart Inst St Luke’s Episcopal Hosp Texas Child Hosp. 2002;29(3):164–71.
3. Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW. Coronary revascularization trends in the United States, 2001–2008. JAMA: J Am Med Assoc. 2011;305(17):1769–76. doi:10.1001/jama.2011.551.
4. Elixhauser A, Andrews RM. Profile of inpatient operating room procedures in US hospitals in 2007. Arch Surg. 2010;145(12):1201–8. doi:10.1001/archsurg.2010.269.
5. Ferguson Jr TB. Mortality in coronary artery bypass grafting: what’s next? Circulation. 2012;125(20):2409–11. doi:10.1161/CIRCULATIONAHA.112.106856.
6. Ferguson Jr TB, Hammill BG, Peterson ED, DeLong ER, Grover FL, Committee STSND. A decade of change–risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990–1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Soc Thorac Surg Ann Thorac Surg. 2002;73(2):480–9. discussion 9–90.
7. ElBardissi AW, Aranki SF, Sheng S, O’Brien SM, Greenberg CC, Gammie JS. Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database. J Thorac Cardiovasc Surg. 2012;143(2):273–81. doi:10.1016/j.jtcvs.2011.10.029.
8. Becker ER, Rahimi A. Disparities in race/ethnicity and gender in in-hospital mortality rates for coronary artery bypass surgery patients. J Natl Med Assoc. 2006;98(11):1729–39.
9. Konety SH, Vaughan Sarrazin MS, Rosenthal GE. Patient and hospital differences underlying racial variation in outcomes after coronary artery bypass graft surgery. Circulation. 2005;111(10):1210–6. doi:10.1161/01.cir.0000157728.49918.9f. This study found that black patients undergoing CABG have higher mortality at both early (30-day) and late (90-day and 1-year) follow-up, compared to white patients.
10. Egede LE. Race, ethnicity, culture, and disparities in health care. J Gen Intern Med. 2006;21(6):667–9. doi:10.1111/j.1525-1497.2006.0512.x.
11. Williams DR, Jackson PB. Social sources of racial disparities in health. Health Aff (Project Hope). 2005;24(2):325–34. doi:10.1377/hlthaff.24.2.325.
12. Kaul P, Lytle BL, Spertus JA, DeLong ER, Peterson ED. Influence of racial disparities in procedure use on functional status outcomes among patients with coronary artery disease. Circulation. 2005;111(10):1284–90. doi:10.1161/01.cir.0000157731.66268.e1.
13. Holmes JS, Arispe IE, Moy E. Heart disease and prevention: race and age differences in heart disease prevention, treatment, and mortality. Med Care. 2005;43(3 Suppl):I33–41.
14. Rangrass G, Ghaferi AA, Dimick JB. Explaining racial disparities in outcomes after cardiac surgery: the role of hospital quality. JAMA Surg. 2014;149(3):223–7. doi:10.1001/jamasurg.2013.4041. This study found that 34% of the excess CABG mortality in black Medicare beneficiaries was attributable to care at a low-quality hospital.
15. Rumsfeld JS, Plomondon ME, Peterson ED, Shlipak MG, Maynard C, Grunwald GK, et al. The impact of ethnicity on outcomes following coronary artery bypass graft surgery in the Veterans Health Administration. J Am Coll Cardiol. 2002;40(10):1786–93.
16. Gray RJ, Nessim S, Khan SS, Denton T, Matloff JM. Adverse 5-year outcome after coronary artery bypass surgery in blacks. Arch Intern Med. 1996;156(7):769–73.
17. Flattery MP, Baker KM. Evidence for racial disparity in cardiac transplantation survival rates. J Cult Divers. 2004;11(1):25–30.
18. Stewart D, Johnson W, Saunders E. Hypertension in black Americans as a special population: why so special? Current Cardiol Rep. 2006;8(6):405–10.
19. Horikawa Y, Oda N, Cox NJ, Li X, Orho-Melander M, Hara M, et al. Genetic variation in the gene encoding calpain-10 is associated with type 2 diabetes mellitus. Nat Genet. 2000;26(2):163–75. doi:10.1038/79876.
20. Ito K, Bick AG, Flannick J, Friedman DJ, Genovese G, Parfenov MG, et al. Increased burden of cardiovascular disease in carriers of APOL1 genetic variants. Circ Res. 2014;114(5):845–50. doi:10.1161/CIRCRESAHA.114.302347.
21. Krauss RM, Mangravite LM, Smith JD, Medina MW, Wang D, Guo X, et al. Variation in the 3-hydroxyl-3-methylglutaryl coenzyme a reductase gene is associated with racial differences in low-density lipoprotein cholesterol response to simvastatin treatment. Circulation. 2008;117(12):1537–44. doi:10.1161/CIRCULATIONAHA.107.708388.
22. Burroughs VJ, Maxey RW, Levy RA. Racial and ethnic differences in response to medicines: towards individualized pharmaceutical treatment. J Natl Med Assoc. 2002;94(10 Suppl):1–26.
23. Ergul A, Tackett RL, Puett D. Distribution of endothelin receptors in saphenous veins of African Americans: implications of racial differences. J Cardiovasc Pharmacol. 1999;34(3):327–32.
24. Royal CD, Dunston GM. Changing the paradigm from ‘race’ to human genome variation. Nat Genet. 2004;36(11 Suppl):S5–7. doi:10.1038/ng1454.
25. Bamshad M, Wooding S, Salisbury BA, Stephens JC. Deconstructing the relationship between genetics and race. Nat Rev Genet. 2004;5(8):598–609. doi:10.1038/nrg1401.
26. Pearce N, Foliaki S, Sporle A, Cunningham C. Genetics, race, ethnicity, and health. BMJ. 2004;328(7447):1070–2. doi:10.1136/bmj.328.7447.1070.
27. Braun L. Race, ethnicity, and health: can genetics explain disparities? Perspect Biol Med. 2002;45(2):159–74.
28. Jones RG, Trivedi AN, Ayanian JZ. Factors influencing the effectiveness of interventions to reduce racial and ethnic disparities in health care. Soc Sci Med. 2010;70(3):337–41. doi:10.1016/j.socscimed.2009.10.030.
29. Fredericks S, Lo J, Ibrahim S, Leung J. An examination of the difference in performance of self-care behaviours between white and non-white patients following CABG surgery: a secondary analysis. Can J Cardiovasc Nurs = J Can Soins Infirmiers Cardio-Vasculaires. 2010;20(4):21–9.
30. Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Review: MCRR. 2000;57 Suppl 1:108–45.
31. Hines PM, Boyd-Franklin N. African American families. Ethn Fam Ther. 2005;3:87–100.
32. DeNavas-Walt C. Income, Poverty, and Health Insurance Coverage in the United States (2005). DIANE Publishing; 2010.
33. Popescu I, Nallamothu BK, Vaughan-Sarrazin MS, Cram P. Racial differences in admissions to high-quality hospitals for coronary heart disease. Arch Intern Med. 2010;170(14):1209–15. doi:10.1001/archinternmed.2010.227.
34. Gordon HS, Pugach O, Berbaum ML, Ford ME. Examining patients’ trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure. Patient Educ Couns. 2014. doi:10.1016/j.pec.2014.07.022.
35. Kressin NR, Clark JA, Whittle J, East M, Peterson ED, Chang BH, et al. Racial differences in health-related beliefs, attitudes, and experiences of VA cardiac patients: scale development and application. Med Care. 2002;40(1 Suppl):I72–85.
36. Yeung M, Kerrigan J, Sodhi S, Huang PH, Novak E, Maniar H, et al. Racial differences in rates of aortic valve replacement in patients with severe aortic stenosis. Am J Cardiol. 2013;112(7):991–5. doi:10.1016/j.amjcard.2013.05.030.
37. Gordon HS, Paterniti DA, Wray NP. Race and patient refusal of invasive cardiac procedures. J Gen Intern Med. 2004;19(9):962–6. doi:10.1111/j.1525-1497.2004.30131.x.
38. Lucas FL, Stukel TA, Morris AM, Siewers AE, Birkmeyer JD. Race and surgical mortality in the United States. Ann Surg. 2006;243(2):281–6. doi:10.1097/01.sla.0000197560.92456.32.
39. Groeneveld PW, Laufer SB, Garber AM. Technology diffusion, hospital variation, and racial disparities among elderly Medicare beneficiaries: 1989–2000. Med Care. 2005;43(4):320–9.
40. Liu JH, Zingmond DS, McGory ML, SooHoo NF, Ettner SL, Brook RH, et al. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA: J Am Med Assoc. 2006;296(16):1973–80. doi:10.1001/jama.296.16.1973.
41. Smith DB. Addressing racial inequities in health care: civil rights monitoring and report cards. J Health Polit Policy Law. 1998;23(1):75–105.
42. Sarrazin MV, Campbell M, Rosenthal GE. Racial differences in hospital use after acute myocardial infarction: does residential segregation play a role? Health Aff (Project Hope). 2009;28(2):w368–78. doi:10.1377/hlthaff.28.2.w368. This study found that in areas with higher residential segregation among racial groups, black patients were more likely to receive care for acute myocardial infarction at low-quality hospitals.
43. Popescu I, Cram P, Vaughan-Sarrazin MS. Differences in admitting hospital characteristics for black and white Medicare beneficiaries with acute myocardial infarction. Circulation. 2011;123(23):2710–6. doi:10.1161/CIRCULATIONAHA.110.973628.
44. Dimick J, Ruhter J, Sarrazin MV, Birkmeyer JD. Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions. Health Aff (Project Hope). 2013;32(6):1046–53. doi:10.1377/hlthaff.2011.1365. This study found that black patients were more likely to reside closer to a high quality hospital with low CABG mortality, but were more likely to undergo CABG at a farther high-mortality, low-quality hospital.
45. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159(9):997–1004.
46. Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19(2):101–10.
47. Saha S, Taggart SH, Komaromy M, Bindman AB. Do patients choose physicians of their own race? Health Aff (Project Hope). 2000;19(4):76–83.
48. Komaromy M, Grumbach K, Drake M, Vranizan K, Lurie N, Keane D, et al. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334(20):1305–10. doi:10.1056/NEJM199605163342006.
49. Smedley BD, Stith AY, Nelson AR. Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003.
50. Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351(6):575–84. doi:10.1056/NEJMsa040609.
51. Mukamel DB, Weimer DL, Buchmueller TC, Ladd H, Mushlin AI. Changes in racial disparities in access to coronary artery bypass grafting surgery between the late 1990s and early 2000s. Med Care. 2007;45(7):664–71. doi:10.1097/MLR.0b013e3180325b81.
52. Mukamel DB, Weimer DL, Mushlin AI. Referrals to high-quality cardiac surgeons: patients’ race and characteristics of their physicians. Health Serv Res. 2006;41(4 Pt 1):1276–95. doi:10.1111/j.1475-6773.2006.00535.x.
53. Jha AK, Orav EJ, Li Z, Epstein AM. Concentration and quality of hospitals that care for elderly black patients. Arch Intern Med. 2007;167(11):1177–82. doi:10.1001/archinte.167.11.1177.
54. Chan PS. The gap in current disparities research: a lesson from the community. Circ Cardiovasc Qual Outcome. 2014. doi:10.1161/CIRCOUTCOMES.114.001234.
55. Jha AK, Zaslavsky AM. Quality reporting that addresses disparities in health care. JAMA: J Am Med Assoc. 2014;312(3):225–6. doi:10.1001/jama.2014.7204.
56. Wimmer NJ, Spertus JA, Kennedy KF, Anderson HV, Curtis JP, Weintraub WS, et al. Clinical prediction model suitable for assessing hospital quality for patients undergoing carotid endarterectomy. J Am Heart Assoc. 2014;3(3):e000728. doi:10.1161/JAHA.113.000728.
57. Lurie N. Health disparities—less talk, more action. N Engl J Med. 2005;353(7):727–9. doi:10.1056/NEJMe058143.
58. Jha AK, Fisher ES, Li Z, Orav EJ, Epstein AM. Racial trends in the use of major procedures among the elderly. N Engl J Med. 2005;353(7):683–91. doi:10.1056/NEJMsa050672.
59. Fouad M, Wynn T, Martin M, Partridge E. Patient navigation pilot project: results from the Community Health Advisors in Action Program (CHAAP). Ethn Dis. 2010;20(2):155–61.
60. Esnaola NF, Hall BL, Hosokawa PW, Ayanian JZ, Henderson WG, Khuri SF, et al. Race and surgical outcomes: it is not all black and white. Ann Surg. 2008;248(4):647–55. doi:10.1097/SLA.0b013e31818a159a.
61. O’Connor GT, Plume SK, Olmstead EM, Morton JR, Maloney CT, Nugent WC, et al. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. North N Engl Cardiovasc Dis Study Group JAMA: J Am Med Assoc. 1996;275(11):841–6.
62. Siegel B, Sears V, Bretsch JK, Wilson M, Jones KC, Mead H, et al. A quality improvement framework for equity in cardiovascular care: results of a national collaborative. J Healthcare Qual: Off Publ Ntnl Assoc Healthcare Qual. 2012;34(2):32–42. doi:10.1111/j.1945-1474.2011.00196.x. quiz −3.
63. Epstein AM. Paying for performance in the United States and abroad. N Engl J Med. 2006;355(4):406–8. doi:10.1056/NEJMe068131.
64. Stulberg J. The physician quality reporting initiative–a gateway to pay for performance: what every health care professional should know. Qual Manag Health Care. 2008;17(1):2–8. doi:10.1097/01.QMH.0000308632.74355.93.
65. Bhalla R, Schechter CB, Strelnick AH, Deb N, Meissner P, Currie BP. Pay for performance improves quality across demographic groups. Qual Manag Health Care. 2013;22(3):199–209. doi:10.1097/QMH.0b013e31829a6b4f.
66. Ryan A, Sutton M, Doran T. Does winning a pay-for-performance bonus improve subsequent quality performance? Evidence from the Hospital Quality Incentive Demonstration. Health Serv Res. 2014;49(2):568–87. doi:10.1111/1475-6773.12097.
67. Nallamothu BK, Saint S, Ramsey SD, Hofer TP, Vijan S, Eagle KA. The role of hospital volume in coronary artery bypass grafting: is more always better? J Am Coll Cardiol. 2001;38(7):1923–30.
68. Grumbach K, Anderson GM, Luft HS, Roos LL, Brook R. Regionalization of cardiac surgery in the United States and Canada. Geographic access, choice, and outcomes. JAMA: J Am Med Assoc. 1995;274(16):1282–8.
69. Mirvis DM, Graney MJ. Impact of race and age on the effects of regionalization of cardiac procedures in the Department of Veterans Affairs Health Care System. Am J Cardiol. 1998;81(8):982–7.
70. National Conference of State Legislatures. Health Disparities: State Laws. http://www.ncsl.org/research/health/health-disparities-laws.aspx. 2014. Accessed November 15 2014.