The Effect of Race on the Referral Process for Invasive Cardiac Procedures

Abstract

Coronary artery disease is the leading cause of death in the United States. Blacks are more likely than whites to experience premature disease, and they have poorer prognosis after acute myocardial infarction. Multiple studies have demonstrated that blacks are less likely to be referred for certain invasive cardiac procedures. Few studies have examined the effect of race on physician and patient decision making in referrals for cardiac procedures. The authors present a framework for the complex series of steps involved in obtaining invasive cardiac care. Patient race can affect each of these steps, and differences in physician and patient race may be a particular impediment to effective communication about symptoms and preferences and to the establishment of a therapeutic partnership. The potential role of communication in race-discordant physician-patient relationships suggests a need for more research in physician decision making and for efforts to promote cultural competency as a core component of medical education.

Mortality After Acute Myocardial Infarction in Hospitals That Disproportionately Treat Black Patients

“…44 -46 Similarly, it could be the case that overall revascularization rates in hospitals with a large fraction of black patients could be lower, as suggested by previous research documenting racial gaps in surgical treatment of cardiovascular disease. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]43 These explanations alone cannot explain the gradient, because the regression analysis adjusted for such factors. A plausible explanation is that differences in hospitallevel quality not adequately adjusted for in the present analysis but highlighted in recent studies, such as time to reperfusion, the prescription of ␤-blockers, postsurgical mortality, or the quality of physicians, could explain observed differences in outcomes.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]43 To capture these effects, hospital-specific rates of CABG and percutaneous coronary interventions in the sample were included in 1 specification of the regression. Third, hospitals may differ with respect to average volume of treatment.…”

Racial and Ethnic Disparities in the Quality of Health Care

“…Health care is based largely on a series of cascading decisions made by patients and their providers (43). These decisions reflect different cognitive processes (81).…”

The human face of health disparities

“…3,4 Communication barriers, problems in the doctor-patient relationship, and bias have been proposed as more important explanations of the differences measured. 5,6 It remains to be seen to what extent patient preference itself is based on a lack of trust in a health care system that has historically treated African Americans unfairly.…”