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Health care report cards may increase racial/ethnic disparities in bypass operations

d Utilization Project (HCUP-3), a data set that includes hospital discharge information nation-wide. Researchers only used data from the 12 states in HCUP-3 that reported patient race, which were California, Colorado, Connecticut, Florida, Iowa, Kansas, Massachusetts, Maryland, Missouri, New Jersey, South Carolina, and Wisconsin.

Werner and her colleagues compared hospital discharge data on 928,551 acute heart attack patients including 310,412 patients in New York. Blacks and Hispanics accounted for 13.7 percent of the New York patients and 10 percent of patients in the comparison states. New York released its first surgeon-specific CABG report card in December 1991. Researchers found that after the report card was released, the gap in CABG surgery in New York between whites versus blacks and Hispanics widened significantly.

Among the New York patients, blacks and Hispanics were less likely to receive CABG than white patients after the report card was released. Prior to the report card, CABG rates were 3.6 percent for whites, 2.9 percent for Hispanics and 0.9 percent for blacks. After the report card's release, even though CABG rates increased overall, the difference in CABG use between white vs. Hispanic patients and white vs. black patients increased (8 percent of white patients vs. 4.8 percent of Hispanic patients and 3 percent of black patients). In the comparison states, the disparity between the races in the same time frame was not statistically significant.

The researchers also note that despite the relatively lower use of CABG among racial and ethnic minorities after the report cards were released in New York, there was no increase in angioplasty procedures often a substitute procedure for CABG in these groups.

These results suggest that some surgeons responded to CABG report cards by excluding some patients from CABG surgery on the basis of race and ethnicity, Werner said. "It's possible that physicians believe that minority pa
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
15-Mar-2005


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