Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations

Schoenfeld, Andrew J.; Sturgeon, Daniel; Dimick, Justin B.; Bono, Christopher M.; Blucher, Justin A.; Barton, Lauren B.; Weissman, Joel S.; Haider, Adil H.

doi:10.1097/sla.0000000000002695

Cited by 48 publications

(32 citation statements)

References 28 publications

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“…In other fields, disparities in access to health care has been demonstrated for women, racial minorities, and individuals with low English proficiency. 4-7 With respect to cochlear implantation, similar findings have been identified for at-risk demographic groups, although no large-scale demographic study has been performed to date. 2,8,9…”

Section: Introductionmentioning

confidence: 67%

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

Tolisano

Schauwecker

Baumgart

et al. 2019

Ann Otol Rhinol Laryngol

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Objective: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. Methods: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. Results: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). Conclusion: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.

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Section: Introductionmentioning

confidence: 67%

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

Tolisano

Schauwecker

Baumgart

et al. 2019

Ann Otol Rhinol Laryngol

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“…ACO participation has been shown to reduce readmissions following major surgery, though almost all of the effect appeared due to synergy with the Hospital Readmissions and Reduction Policy. 28 Conversely, ACO participation did not reduce disparities in surgical care for racial and ethnic minorities 29 or improve outcomes after major cancer surgery. 30 This study must be considered in the context of several limitations.…”

Section: Discussionmentioning

confidence: 97%

Medicare Accountable Care Organizations and Use of Potentially Low-Value Procedures

et al. 2018

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Objective. To evaluate the effect of Accountable Care Organizations (ACOs) on the use of vertebroplasty and arthroscopic partial meniscectomy, 2 procedures for which randomized controlled trials suggest similar outcomes to sham surgery and therefore may provide low value. Medicare Shared Savings Program ACOs aim to improve quality and decrease health care spending. Reducing the use of potentially low-value procedures can accomplish both of these goals. Methods. We performed a retrospective cohort study of patients who underwent potentially low-value orthopedic procedures (vertebroplasty and partial meniscectomy) and a control (hip fracture) from 2010 to 2015 using a 20% sample of national Medicare claims. We performed an interrupted time-series analysis using linear spline models to evaluate the count of each procedure per 1000 patients, stratified by ACO participation. Results. We identified 76 256 patients who underwent arthroscopic partial meniscectomy, 44 539 patients who underwent vertebroplasty, and 50 760 patients who underwent hip fracture admission. Arthroscopic partial meniscectomy rates decreased, vertebroplasty rates remained stable, and hip fracture rates increased for both groups during the study period, with similar trends among ACO and non-ACO patients. After January 1, 2013, ACO and non-ACO populations had similar trends for vertebroplasty (ACO incidence rate ratio [IRR] = 1.

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“…Racial disparities and access to medical care have been increasingly recognized as having a direct impact on disease presentation [20][21][22]. Furthermore, patients undergoing colorectal surgery requiring an ostomy typically use more health care resources and have the potential for more postoperative complications [23,24].…”

Section: Discussionmentioning

confidence: 99%

Racial disparities after stoma construction in colorectal surgery

et al. 2020

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Aim Racial disparities are under‐recognized among patients undergoing colorectal surgery. The purpose of this study was to determine the complication rates and surgical outcomes stratified by race and ethnicity among patients undergoing colorectal surgery with intestinal stoma creation. Method The ACS NSQIP database from 2013 to 2016 was used. Colon, rectum and small bowel cases requiring intestinal stoma creation were selected. Both African‐American and other groups of minority patients were compared with Caucasian patients using a complex multivariable analysis model. Primary outcomes of interest were complication rates, mortality and extended hospital length of stay. Results The study included 38 088 admissions. After multivariable analysis, African‐American patients still had a prolonged length of hospital stay and higher complication rates. Other minorities also had a prolonged length of hospital stay and higher complication rates. Conclusions Both African‐American and other groups of minority patients requiring an ostomy suffer significantly higher postoperative complication rates and a prolonged hospital length of stay, even after comorbidity adjustment. Access to care, socioeconomic status and comorbid disease management are all important factors for minority patients who undergo colorectal surgery requiring intestinal stoma construction.

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Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations

Cited by 48 publications

References 28 publications

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

Medicare Accountable Care Organizations and Use of Potentially Low-Value Procedures

Racial disparities after stoma construction in colorectal surgery

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