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Hospital volume doesn't explain racial disparity in cardiovascular procedure deaths

Although hospitals that perform fewer cardiovascular procedures tend to have higher death rates than higher-volume hospitals, and although African-American and Hispanic patients tend to be treated at lower-volume hospitals, differences in volume do not explain racial disparities in cardiovascular procedure death rates, according to a new study in the Jan. 17, 2006, issue of the Journal of the American College of Cardiology.

"Our results have two important implications: one, clinicians should recognize that black patients face markedly higher mortality after some cardiovascular procedures, with up to a two-fold increase in the risk of post-procedure death; and two, although better access to high-volume hospitals may improve outcomes for both white and minority patients, this increased use of high-volume hospitals is unlikely to eliminate racial differences in post-procedure mortality. Future research should explore other factors that could explain racial differences in death rates following these cardiovascular procedures and develop interventions to reduce these mortality rates," said Amal N. Trivedi, M.D., M.P.H., from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts.

Studies of health care quality have consistently indicated that "practice makes perfect;" that is, other things being equal, patients tend to fare better when they are treated by practitioners and institutions that perform a certain number of specific procedures per year. Since black and Hispanic patients are more likely to be treated at hospitals that perform fewer cardiovascular procedures, the volume-quality link was considered to be one possible explanation for higher death rates among minority patients following cardiovascular procedures.

The researchers focused in on that hypothesis by using data on hundreds of thousands of heart bypass surgeries, angioplasty procedures, abdominal aortic aneurysm repairs and carotid end
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Contact: Amy Murphy
amurphy@acc.org
301-581-3476
American College of Cardiology
13-Jan-2006


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