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PHP 0310 (32)
Ira Wilson (32)
Lecture 27

PHP 0310 Lecture 27: 04-12 Healthcare Disparities 2

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Brown University
Public Health
PHP 0310
Ira Wilson

Relationship between Improving Quality and Reducing Disparities in Health • Patients' race affects clinical decision-making o 720 physicians shown a recorded interview from hypothetical patients about their chest pain, asked to make recommendations about cardiac testing o Varied only age, gender, and race o Race and gender interaction disparity: black females least likely to be referred for cardiac catheterization • IOM Report: unequal treatment, disparities in healthcare o Disparities in healthcare delivered to racial and ethnic minorities are real and associated with worse outcomes o Disparities exist even when insurance status, income, age, severity of conditions are comparable/controlled o Minorities less likely than whites to receive needed services o Differences in treating heart disease, cancer, HIV infection partly contribute to higher death rates for minorities • Timeline of healthcare disparity research o Documenting disparities: do disparities exist? Yes • Difference in door-to-balloon times for STEMI patients ▪ 20 minute difference in restoration of blood flow between white and black patients, even adjusted for where patients get care o Understanding mediators: why do they exist? • Site of care: safety net hospitals have fewer services/advanced technology ▪ Distribution of white/black Medicare Enrollees among PCPs ▪ Very few black patients are seen by physicians on the left ▪ 20% of providers account for 80% of all visits delivered to black patients ▪ These 20% report more likely to report challenges in getting specialty care, not enough time to see patients, lower reimbursement rates • Mortality after AMI by average percentage of black patients admitted to the hospital ▪ Lowest decile: no black patients ▪ As the fraction of black patients in the hospital increases, the mortality rates are worse for both white and black ▪ Highest decile of black patients: outcomes for white patients are worse than outcomes for black patients seen in lower decile hospitals ▪ Similar relationship in nursing homes o Developing interventions • What is the impact of general quality improvement (to all patients, not just a focused effort to remedy disparities) on racial and ethnic disparities in care? ▪ It's possible that improving quality can also reduce disparities because quality improvement measures are supposed to reduce unwanted variatio
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