Surgical Disparities: A Comprehensive Review and New Conceptual Framework

Torain, Maya; Maragh-Bass, Allysha C.; Dankwa-Mullen, Irene; Hisam, Butool; Kodadek, Lisa M.; Lilley, Elizabeth J.; Najjar, Peter A.; Changoor, Navin R.; Rose, John; Zogg, Cheryl K.; Maddox, Yvonne T.; Britt, L. D.; Haider, Adil H.

doi:10.1016/j.jamcollsurg.2016.04.047

Cited by 133 publications

(90 citation statements)

References 82 publications

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“…Previous studies suggest that compared to white patients, black patients may lack adequate access to ambulatory and rehabilitation services, have less appropriate social and community support, and have lower health literacy-all of which may lead to less optimal postdischarge care and increased risk for readmissions among black patients. 1,2,6,7 The racial disparities in thirty-day readmissions among traditional Medicare beneficiaries in 2013 coincide with recent evidence that overall thirty-day readmission rates, 9,10 including for surgical populations, declined during the post-ACA period. A recent Department of Human and Health Services report shows that during 2012-13 the reduced readmission rate (which fell from 18.5 percent to 17.5 percent) translated into 150,000 fewer hospital readmissions among traditional Medicare beneficiaries.…”

Section: Discussionmentioning

confidence: 81%

“…Our findings of racial disparities in thirty-day surgical readmissions among traditional Medicare beneficiaries were consistent with results of previous studies. [1][2][3][4][5] Multiple factors may underlie such disparities. For example, black patients may receive lower-quality surgical care in the hospital, compared to their white counterpartsa mechanism that is supported by results in our sensitivity analyses showing that disparities occurring within the same index hospitalization might play an important role (see the Appendix).…”

Section: Discussionmentioning

confidence: 99%

“…acial disparities in surgical outcomes, such as postoperative complications, mortality, and thirtyday rehospitalizations, have been well documented. [1][2][3][4][5][6] Excess readmissions within thirty days of surgical discharge reduce both patient quality of life and the efficiency of health care. Evidence suggests that thirty-day surgical readmission rates vary substantially across hospitals and geographic areas, and that such variations are largely attributable to patient factors such as sociodemographic characteristics, preexisting comorbidities, and postoperative complications.…”

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confidence: 99%

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Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions

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Cai

et al. 2017

Health Affairs

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We compared racial disparities in thirty-day readmissions between traditional Medicare and Medicare Advantage beneficiaries who underwent one of six major surgeries in New York State in 2013. We found that Medicare Advantage was associated with greater racial disparity, compared to traditional Medicare. After controlling for patient, hospital, and geographic characteristics in a propensity score based approach, we found that in traditional Medicare, black patients were 33 percent more likely than white patients to be readmitted, whereas in Medicare Advantage, black patients were 64 percent more likely than white patients to be readmitted. Our findings suggest that the risk-reduction strategies adopted by Medicare Advantage plans have not been successful in lowering the markedly higher rate of readmission among black patients, compared to white patients.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions

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Cai

et al. 2017

Health Affairs

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“…3–11 These differences in outcomes are thought to result from the broad population health inequalities observed in the United States where income level alone is associated with more than 10 years of decreased life expectancy. 12 Clinical pathways have been found to ameliorate disparities in care.…”

Section: Introductionmentioning

confidence: 99%

Racial and Socioeconomic Differences Manifest in Process Measure Adherence for Enhanced Recovery After Surgery Pathway

Leeds

Alimi

Hobson

et al. 2017

Diseases of the Colon &Amp; Rectum

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BACKGROUND Adherences to care processes and surgical outcomes vary by population subgroups for the same procedure. Enhanced Recovery After Surgery pathways are intended to standardize care but their effect on process adherence and outcomes for population subgroups is unknown. OBJECTIVE To demonstrate the association between recovery pathway implementation, process measures, and short-term surgical outcomes by population subgroup. DESIGN Pre- and post-quality improvement implementation cohort study. SETTING Tertiary academic medical center. INTERVENTION Implementation of a modified colorectal Enhanced Recovery After Surgery pathway. PATIENTS Elective colon and rectal resections prior to (2013) and following (2014–2016) recovery pathway implementation. MAIN OUTCOME MEASURE 30-day outcomes by race and socioeconomic status were analyzed using a difference-in-differences approach with correlation to process adherence. RESULTS We identified 639 cases (199 pre, 440 post). 75.2% were white and 91.7% were high socioeconomic status. Groups were similar in terms of other preoperative characteristics. Following pathway implementation, median lengths of stay improved in all subgroups (−1.0 days overall, p=<0.001), but with no statistical difference by race or socioeconomic status (p=0.89 and p=0.29, respectively). Complication rates in both racial and socioeconomic groups were no different (26.4% vs. 28.8%, p=0.73; 27.3% vs. 25.0%, p=0.86, respectively) and remained unchanged with implementation (p=0.93, p=0.84). By race, overall adherence was 31.7% in white patients and 26.5% in non-white patients (p=0.32). While stratification by socioeconomic status demonstrated decreased overall adherence in the low status group (31.8% vs 17.1%, p=0.05), white patients were more likely to have regional pain therapy (57.1% vs 44.1%. p=0.02) with a similar trend seen with socioeconomic status. LIMITATIONS Data collected primarily for quality improvement purposes. CONCLUSIONS Differences in outcomes by race and socioeconomic status did not arise following implementation of a enhanced recovery pathway. Differences in process measures by population subgroups highlight differences in care that requiring further investigation. See Video Abstract at http://links.lww.com/DCR/AXXX.

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“…1 Addressing socioeconomic disparities for breast reconstruction is challenging and requires an understanding of how socioeconomic status influences decision-making at the patient (eg, transportation, work leave), provider (plastic surgeon availability), and system levels (acceptance of diverse insurance types). 2 How these factors interact to influence receipt of reconstruction likely varies between communities. The majority of state health departments form statewide health service areas that consider population size and geographic location to inform policy and assess the adequacy of the physician workforce.…”

mentioning

confidence: 99%

Utility of health services regions in examining socioeconomic disparities in receipt of breast reconstruction

et al. 2020

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Surgical Disparities: A Comprehensive Review and New Conceptual Framework

Cited by 133 publications

References 82 publications

Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions

Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions

Racial and Socioeconomic Differences Manifest in Process Measure Adherence for Enhanced Recovery After Surgery Pathway

Utility of health services regions in examining socioeconomic disparities in receipt of breast reconstruction

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