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.

Race and patient refusal of invasive cardiac procedures

“…The referral process for these procedures has several steps where refusal may occur 28 . The low refusal rates we found may be associated with refusal at earlier steps in this process; however, other studies that examined patient refusal were limited by similar factors.…”

Has Pay‐for‐Performance Decreased Access for Minority Patients?

“…Thus, if hospitals in the PHQID avoided minority patients, they must have done so through one or more of these sources of admission. First, while evidence suggests that physicians themselves were not given financial incentives for quality performance in the PHQID (Damberg et al 2007), hospitals may have discouraged community physicians, through a variety of means, from referring minority patients (Einbinder and Schulman 2000; Hargraves, Stoddard, and Trude 2001). Second, hospitals could have decreased minority admissions by creating greater barriers to admission through the ED.…”

Testing for Statistical Discrimination in Health Care

“…An increasing body of literature has documented and condemned disparities originating at the clinical encounter (Bach et al 1999; Schulman et al 1999; Mayberry, Mili, and Ofili 2000; Geiger 2001). Also, conceptual research has identified potential sources of health disparities within the clinical encounter (Einbinder and Schulman 2000; Balsa and McGuire 2001, 2003; Bloche 2001; van Ryn 2001). However, we are aware of no paper trying to measure empirically the magnitude and importance of these different mechanisms.…”