A Quality Improvement Framework for Equity in Cardiovascular Care: Results of a National Collaborative

Siegel, B. Z.; Sears, Vickie; Bretsch, Jennifer K.; Wilson, Marcia J.; Jones, Karen C.; Mead, Holly; Hasnain‐Wynia, Romana; Ayala, Rochelle Knowles; Bhalla, Rohit; Cornue, Christopher M.; Emrich, Christina Marie; Patel, Paru; Setzer, J. R.; Suitonu, Jennifer; Velázquez, Eric J.; Eagle, Kim A.; Winniford, Michael D.

doi:10.1111/j.1945-1474.2011.00196.x

Cited by 17 publications

(11 citation statements)

References 23 publications

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“…In a similar study, Siegel and colleagues [46] highlight the results of the Expecting Success: Excellence in Cardiac Care, a national collaborative project that combined quality improvement efforts with registry data of self-reported patient demographics. The target population was black and Hispanic patients who were discharged with a diagnosis of acute myocardial infarction (AMI) or heart failure (HF).…”

Section: Clinical Practice Guidelinesmentioning

confidence: 99%

Racial Disparities in Cardiovascular Care: A Review of Culprits and Potential Solutions

Capers

Sharalaya

2014

J. Racial and Ethnic Health Disparities

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Cardiovascular disease is the leading cause of death for white and black Americans. Despite the presence of therapies that improve survival and quality of life in cardiac patients, African-Americans continue to have the worst heart disease survival rates of all racial groups. The literature has described racial disparities in cardiovascular care for at least 25 years. We review the current status of racial disparities in four areas of cardiovascular care: automatic implantable cardioverterdefibrillator (AICD) implantations in patients at risk for sudden cardiac death, cardiac resynchronization therapy with defibrillator (CRT-D) implantation in patients with severely depressed left ventricular function and refractory heart failure, reperfusion therapy in patients presenting with acute myocardial infarction, and revascularization in patients with critical limb ischemia. We will discuss potential culprits for these disparities with a particular focus on hospital quality, physician bias, and the relative lack of diversity among cardiovascular physicians in the USA. Finally, we will discuss strategies already in progress that hold promise to reduce or eliminate racial disparities in cardiovascular care.

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Section: Clinical Practice Guidelinesmentioning

confidence: 99%

Racial Disparities in Cardiovascular Care: A Review of Culprits and Potential Solutions

Capers

Sharalaya

2014

J. Racial and Ethnic Health Disparities

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“…However, several studies have highlighted lower CABG utilization rates and worse post‐CABG mortality among women and racial/ethnic minorities, particularly blacks 3, 4, 5, 6, 7. This awareness has spurred multifaceted local and national interventions aimed at narrowing sex‐ and race‐related differences in CABG use and outcomes 8, 9, 10, 11. However, it is not clear whether there has been a concomitant change in the differences in outcomes by sex and race over time.…”

Section: Introductionmentioning

confidence: 99%

Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014

Angraal

Khera

Wang

et al. 2018

JAHA

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BackgroundWith over a decade of directed efforts to reduce sex and racial differences in coronary artery bypass grafting (CABG) utilization, and post‐CABG outcomes, we sought to evaluate how the use of CABG and its outcomes have evolved in different sex and racial subgroups.Methods and ResultsUsing data on all fee‐for‐service Medicare beneficiaries undergoing CABG in the United States from 1999 to 2014, we examined differences by sex and race in calendar‐year trends for CABG utilization and post‐CABG outcomes (in‐hospital, 30‐day, and 1‐year mortality and 30‐day readmission). A total of 1 863 719 Medicare fee‐for‐service beneficiaries (33.6% women, 4.6% black) underwent CABG from 1999 to 2014, with a decrease from 611 to 245 CABG procedures per 100 000 person‐years. Men compared with women and whites compared with blacks had higher CABG utilization, with declines in all subgroups. Higher post‐CABG annual declines in mortality (95% confidence interval) were observed in women (in‐hospital, −2.70% [−2.97, −2.44]; 30‐day, −2.29% [−2.54, −2.04]; and 1‐year mortality, −1.67% [−1.88, −1.46]) and blacks (in‐hospital, −3.31% [−4.02, −2.60]; 30‐day, −2.80% [−3.49, −2.12]; and 1‐year mortality, −2.38% [−2.92, −1.84]), compared with men and whites, respectively. Mortality rates remained higher in women and blacks, but differences narrowed over time. Annual adjusted 30‐day readmission rates remained unchanged for all patient groups.ConclusionsWomen and black patients had persistently higher CABG mortality than men and white patients, respectively, despite greater declines over the time period. These findings indicate progress, but also the need for further progress.

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“…16,17 In addition, testing strategies in safety net settings will help ensure that the study findings are applicable to low income and minority populations.…”

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confidence: 99%

“…15 Implementing population health management strategies in settings that serve large numbers of patients from low income and minority populations may be an effective way to reduce disparities. 16,17 In addition, testing strategies in safety net settings will help ensure that the study findings are applicable to low income and minority populations.…”

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confidence: 99%

Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers

Persell

Brown

Lee

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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T he risk of developing cardiovascular disease (CVD) can be greatly reduced through lifestyle and medical therapies that address diet, overweight and obesity, smoking, dysplipidemia, hypertension, and diabetes mellitus. Irrespective of which factors are contributing on an individual's risk for the development of CVD, treatment with statins safely and effectively reduces morbidity and mortality from CVD. 1,2The recent American College of Cardiology/American Heart Association cholesterol treatment guideline emphasizes identifying and treating individuals at risk for developing CVD. 3 However, fewer than half of high-risk individuals are treated with statins. 4,5 Statin use is lower among blacks, 4,6 Hispanics, 5,6 the uninsured, 7 and poorer individuals. 8,9 Reducing the population burden of CVD and decreasing disparities will require maximizing the use of preventive strategies among all individuals likely to benefit from them.Statins may be underused for primary prevention for several reasons. Clinicians and patients may not readily appreciate increased CVD risk, particularly when risk comes from factors other than elevated cholesterol. 10,11 Patients may also Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states.Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, [12][13][14] Outreach interventions focused on addressing this risk could increase the number of high-risk patients who seek out treatment. 15Implementing population health management strategies in settings that serve large numbers of patients from low income and minority populations may be an effective way to reduce disparities. 16,17 In addition, testing strategies in safety net settings will help ensure that the study findings are applicable to low income and minority populations.We hypothesized that m...

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A Quality Improvement Framework for Equity in Cardiovascular Care: Results of a National Collaborative

Cited by 17 publications

References 23 publications

Racial Disparities in Cardiovascular Care: A Review of Culprits and Potential Solutions

Racial Disparities in Cardiovascular Care: A Review of Culprits and Potential Solutions

Sex and Race Differences in the Utilization and Outcomes of Coronary Artery Bypass Grafting Among Medicare Beneficiaries, 1999–2014

Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers

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