Physician Networks and the Racial Gap in Hospital Quality of Care for Coronary Heart Disease

医生网络和医院冠心病护理质量的种族差距

• 批准号: 10421076
• 负责人: Ioana Popescu
• 金额: $ 69.9万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10421076
• 关键词: Acute myocardial infarction; Address; Affect; Aging; Area; Black Populations; Cardiac; Cardiovascular Diseases; Caring; Censuses; Characteristics; Coronary Artery Bypass; Coronary heart disease; Data; Data Analyses; Diabetes Mellitus; Economic Burden; Emergency Situation; Geographic Locations; Goals; Hospital Referrals; Hospitalization; Hospitals; Insurance Claim Review; Intervention; Lead; Link; Malignant Neoplasms; Measures; Methods; Minority; Modeling; Older Population; Operative Surgical Procedures; Pathway Analysis; Patient Preferences; Patient Self-Report; Patients; Perception; Physician' s Role; Physicians; Play; Policies; Policy Maker; Population; Procedures; Process; Provider; Public Health; Quality of Care; Quality of life; Reporting; Research; Resource Allocation; Resources; Role; Sampling; Services; Social Network; Specialist; Surveys; Techniques; Work; base; black patient; black/white disparity; community partnership; design; disparity reduction; econometrics; health care disparity; improved; medical specialties; racial disparity; residential segregation; response; segregation; simulation; treatment disparity

Project Summary/ Abstract White-black disparities in the treatment of coronary heart disease (CHD) are due in part to differences in the quality of hospitals used by black and white patients, and studies suggest that non-geographic factors play an important role. Such non-geographic factors likely include differences in the physicians caring for black and white patients with CHD. In support of this hypothesis, research has shown that the care of black patients is concentrated within a small number of physicians, who report lower access to specialists and hospitals, and may be more isolated professionally. In addition, research has shown that black and white patients may be treated differently even when they are cared for by the same physicians or physician referral networks. Whether differences among physicians caring for black and white seniors with CHD contribute to the racial gap in hospital quality remains unknown. The overarching goal of this proposal is to identify and characterize physicians and networks treating black and white seniors with CHD, and to investigate the physician and network factors associated with the racial gap in high quality hospital use using a combination of state of the art social network and econometric data analyses, and surveys directed at physicians caring for black and white patients. The study will include seniors in 35 metro areas with sizable black and white populations and include two cardiac conditions: acute myocardial infarction (AMI), an emergency condition typically requiring transport to the nearest hospital, and coronary artery bypass grafting surgery (CABG), a frequently elective procedure involving specialty referral. Study aims will sequentially construct metro-level networks; identify sub-networks of physicians within the larger metro area that are likely to work together (i.e., referral networks); measure network segregation; measure physician and sub-network characteristics that may be relevant for hospital access and the referral process; survey a sample of physicians within these networks to understand self-reported difficulties with the referral process; estimate regression models to assess the effects of physicians and their measured and self-reported characteristics on the white-black gap in high quality hospital use for CHD; and employ simulations to assess potential policy effects achieved by modifying relevant characteristics. The study will address important, previously unanswered questions about physician referral networks for black and white seniors with CHD in diverse US metro areas. Are networks segregated, and to what degree is network segregation correlated with residential segregation? Are characteristics of physicians and sub-networks used by black and white seniors with CHD (e.g., physician qualifications and the centrality of cardiologists within a sub-network) different and do they affect the use of high quality hospitals? The study will address these important research and policy questions.

项目摘要/摘要 冠心病（CHD）治疗中的白色黑色差异部分是由于 黑白患者使用的医院质量的差异，研究表明 非地理因素起着重要作用。这样的非地理因素可能包括 照顾黑白冠心病患者的医生的差异。支持这个 假设，研究表明，黑人患者的护理集中在一个小的 医生的数量，报告较低的专家和医院的机会，并且可能更多 专业孤立。此外，研究表明黑白患者可能是 即使受到同一医生或医师推荐的照顾，也有不同的治疗 网络。照顾黑白老年人的医生之间的差异是否存在 导致医院质量种族差距的贡献尚不清楚。 该提案的总体目标是识别和表征医生和网络 用CHD治疗黑白老年人，并调查医师和网络因素 与高质量医院使用的种族差距相关联的使用状态 社交网络和计量经济学数据分析，并针对关心的医生进行调查 黑白患者。该研究将包括35个都有相当黑色的都会区的老年人 和白人种群，包括两个心脏病：急性心肌梗塞（AMI）， 紧急情况通常需要运输到最近的医院和冠状动脉 旁路嫁接手术（CABG），这是一种涉及专业推荐的经常选择的程序。 研究目标将依次构建Metro级网络；确定医生的子网络 在较大的都市区域内，可能会一起工作（即推荐网络）；措施 网络隔离；测量可能相关的医师和子网络特征 用于住院和转诊过程；调查其中的医生样本 通过转介过程了解自我报告的困难的网络；估计回归 评估医生及其测量和自我报告特征的影响的模型 在高质量医院的白色差距上用于CHD；并采用模拟来评估 通过修改相关特征实现的潜在政策影响。 这项研究将解决有关医师转诊的重要，以前未解决的问题 黑白老年人的网络在美国都会区不同。是网络 隔离，网络隔离在多大程度上与住宅隔离相关？ 是黑白老年人使用的医师和子网络的特征 （例如，医师资格和子网中心脏病学家的中心地位）不同 它们会影响使用高质量医院吗？该研究将解决这些重要的 研究和政策问题。

项目成果

Within-Physician Differences in Patient Sharing Between Primary Care Physicians and Cardiologists Who Treat White and Black Patients With Heart Disease.

• DOI: 10.1161/jaha.123.030653
• 发表时间: 2023-11-20
• 期刊: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• 影响因子: 5.4
• 作者: Matthews, Luke J.;Damberg, Cheryl L.;Zhang, Shiyuan;Escarce, Jose J.;Gibson, C. Ben;Schuler, Megan;Popescu, Ioana
• 通讯作者: Popescu, Ioana