Persistent Disparities in Postmastectomy Breast Reconstruction and Strategies for Mitigation

Butler, Paris D.; Morris, Martin P.; Momoh, Adeyiza O.

doi:10.1245/s10434-021-10487-z

Cited by 31 publications

(11 citation statements)

References 64 publications

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“…21,22 Previous studies examining the distribution of resources across demographics showed significant disparities among racial and socioeconomic groups with varying affordability and availability of reconstructive services. 21,23 Further, access to postmastectomy reconstruction has been shown to be influenced by referral patterns of oncologists and general surgeons. 9,23,24 To address these barriers, the 1998 WHCRA was introduced at the national level to mandate insurance coverage of postmastectomy breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Postmastectomy reconstruction has now been integrated into the standard of care for breast cancer because of its documented benefits for patient health-related quality of life, body image, and psychosexual well-being 21,22 . Previous studies examining the distribution of resources across demographics showed significant disparities among racial and socioeconomic groups with varying affordability and availability of reconstructive services 21,23 . Further, access to postmastectomy reconstruction has been shown to be influenced by referral patterns of oncologists and general surgeons 9,23,24 .…”

Section: Discussionmentioning

confidence: 99%

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Return of the Flap; The Empire State Mandate

Asadourian

Chen²,

Jung³

et al. 2023

Ann Plast Surg

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Purpose Immediate postmastectomy breast reconstruction plays an integral role in patient care because of its psychosocial benefits. New York State (NYS) passed the 2010 Breast Cancer Provider Discussion Law with the aim of increasing patient awareness of reconstructive options through mandating plastic surgery referral at the time of cancer diagnosis. Short-term analysis of the years surrounding implementation suggests the law increased access to reconstruction, especially for certain minority groups. However, given the continued presence of disparities in access to autologous reconstruction, we aimed to investigate the longitudinal effects of the bill on access to autologous reconstruction along various sociodemographic cohorts. Methods Retrospective review identified demographic, socioeconomic, and clinical data for patients undergoing mastectomy with immediate reconstruction at Weill Cornell Medicine and Columbia University Irving Medical Center from 2002 to 2019. Primary outcome was receiving implant or autologous-based reconstruction. Subgroup analysis was based on sociodemographic factors. Multivariate logistic regression identified predictors of autologous reconstruction. Interrupted time series modeling analyzed differences in reconstructive trends for subgroups before and after the 2011 implementation of the NYS law. Results We included 3178 patients; 2418 (76.1%) and 760 (23.9%) patients underwent implant and autologous-based reconstruction, respectively. Multivariate analysis indicated that race, Hispanic status, and income were not predictors of autologous reconstruction. Interrupted time series showed that with each year leading up to 2011 implementation, patients were 19% less likely to receive autologous-based reconstruction. Following implementation, there was a 34% increase in the odds of receiving autologous-based reconstruction with each passing year. Following implementation, Asian American and Pacific Islander patients experienced a 55% greater increase in the rate of flap reconstruction than White patients. Following implementation, the highest-income quartile experienced a 26% greater increase in the rate of autologous-based reconstruction compared with the lowest-income quartile. After implementation, Hispanic patients experienced a 30% greater decrease in the rate of autologous-based reconstruction compared with non-Hispanic patients. Conclusions Our data indicate the long-term efficacy of the NYS Breast Cancer Provider Discussion Law in increasing access to autologous-based reconstruction, especially for certain minority groups. These findings underscore the importance of this bill and encourage its adoption into other states.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Return of the Flap; The Empire State Mandate

Asadourian

Chen²,

Jung³

et al. 2023

Ann Plast Surg

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“…16 Although this retrospective study cannot determine causation between minority patient caseloads and MIPS scores, there has been extensive prior work investigating disparities in plastic surgery access and outcomes. 14,[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] There is increased recognition of the role of zip codes in predicting health outcomes, based on historical segregation, community resources, and policy. 21 For example, breast cancer reconstruction rates are higher in areas with a higher density of plastic surgeons, but the rate is lower for nonwhite patients.…”

Section: Discussionmentioning

confidence: 99%

Plastic Surgeons and Equity: Are Merit-based Incentive Payment System (MIPS) Scores Impacted by Minority Patient Caseload?

Byrd

Cichocki

Chung³

2023

Plastic &Amp; Reconstructive Surgery

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Background: The Centers for Medicare and Medicaid Services introduced the Merit-based Incentive Payment System (MIPS) in 2017 to extend value-based payment to outpatient physicians. The authors hypothesized that the MIPS scores for plastic surgeons are impacted by the existing measures of patient disadvantage, minority patient caseload, and dual eligibility. Methods: The authors conducted a retrospective cohort study of plastic surgeons participating in Medicare and MIPS using the Physician Compare national downloadable file and MIPS scores. Minority patient caseload was defined as nonwhite patient caseload. The authors evaluated the characteristics of participating plastic surgeons, their patient caseloads, and their scores. Results: Of 4539 plastic surgeons participating in Medicare, 1257 participated in MIPS in the first year of scoring. The average patient caseload is 85% white, with racial/ethnicity data available for 73% of participating surgeons. In multivariable regression, higher minority patient caseload is associated with a lower MIPS score. Conclusions: As minority patient caseload increases, MIPS scores decrease for otherwise similar caseloads. The Centers for Medicare and Medicaid Services must consider existing and additional measures of patient disadvantage to ensure equitable surgeon scoring.

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“…[16][17][18][19][20] A diverse community of plastic surgeons that reflects the complexity of the United States population is paramount to reducing inequities in access to reconstructive surgeries. 21,22 Additionally, physicians from historically marginalized ethnic backgrounds are more likely to serve minority and underserved communities at a greater frequency than majority physicians. 23 There is recent evidence that patient reported outcomes and compliance can be influenced by the background of the plastic surgeons who treats them.…”

Section: Strength In Diversitymentioning

confidence: 99%

Closing the Gap: Training Experiences and Career Outcomes for Underrepresented Minorities in Plastic Surgery

Diatta

Mellia

Morris

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: The present study assesses training characteristics, scholastic achievements, and traditional career accomplishments of ethnically underrepresented in medicine (UIM) plastic and reconstructive surgery (PRS) faculty relative to non-UIM PRS faculty. Method: A cross-sectional analysis of core PRS faculty appointed to accredited United States residency training programs (n = 99) was performed. Results: Of the 949 US PRS faculty, a total of 51 (5.4%) were identified as UIM. Compared with non-UIM faculty, there were few differences when evaluating medical education, residency training, pursuit of advanced degrees, and attainment of subspecialty fellowship training. UIM faculty were more likely than non-UIM faculty to have graduated from a medical school outside the United States (25% versus 13%, P = 0.014). In addition, UIM faculty did not differ from non-UIM counterparts in traditional career accomplishments, including promotion to full professor, obtaining NIH funding, serving as program director, receiving an endowed professorship, appointment to a peer-reviewed editorial board, scholarly contributions (H-index and number of publications), and appointment to chief/ chair of their division/department. Conclusions: The historical lack of ethnic diversity that comprise US academic PRS faculty persists. This study reveals that those UIM faculty who are able to obtain faculty appointments are equally successful in achieving scholastic success and traditional career accomplishments as their non-UIM counterparts. As we strive toward increasing representation of UIM physicians in academic plastic surgery, the field will benefit from efforts that promote a pipeline for underrepresented groups who traditionally face barriers to entry.

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Persistent Disparities in Postmastectomy Breast Reconstruction and Strategies for Mitigation

Cited by 31 publications

References 64 publications

Return of the Flap; The Empire State Mandate

Return of the Flap; The Empire State Mandate

Plastic Surgeons and Equity: Are Merit-based Incentive Payment System (MIPS) Scores Impacted by Minority Patient Caseload?

Closing the Gap: Training Experiences and Career Outcomes for Underrepresented Minorities in Plastic Surgery

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