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首页> 外文期刊>Health services research: HSR >Referrals to high-quality cardiac surgeons: patients' race and characteristics of their physicians.
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Referrals to high-quality cardiac surgeons: patients' race and characteristics of their physicians.

机译：高质量的心脏外科医生推荐:病人的种族和他们的特征医生。

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OBJECTIVE: To examine the referral process to cardiac surgeons in order to explain racial disparities in access to high-quality cardiac surgeons. DATA SOURCES/STUDY SETTINGS: All white and black Medicare fee-for-service patients undergoing coronary artery bypass graft (CABG) surgery in New York State during 1997-1999. STUDY DESIGN: A retrospective analysis of referral patterns for white and black patients in relation to the quality of the cardiac surgeon, measured by the surgeon's risk-adjusted mortality rate (RAMR), and in relation to characteristics of the physician providing the majority of cardiac care before the surgery. The average RAMRs of the surgeons to whom different physicians referred patients were compared using t-tests and paired t-tests. A hierarchical multivariate regression model was estimated to test hypotheses about the effect of physicians' characteristics on referrals of blacks to low-quality surgeons. DATA EXTRACTION METHOD: Variables were constructed from Medicare claims. PRINCIPAL FINDINGS: The differential in surgeons' quality for white and black patients is partially due to the physician providing the majority of cardiac care before the surgery. There is both across- and within-physician variation in referrals. Of the physician characteristics investigated, only the number of black patients referred to CABG and the percent of all cardiac referrals to the same hospital decrease the difference in surgeons' quality between whites and blacks. CONCLUSIONS: Several different pathways lead blacks to cardiac surgeons of lower quality. Further research is needed to understand the causes and inform policies designed to minimize disparities in access to high-quality providers.
机译：目的:研究转诊过程心脏外科医生为了解释种族获得高质量的心脏之间的差距外科医生。和黑色的医疗保险费用的病人接受冠状动脉旁路移植(CABG)1997 - 1999年期间在纽约州的手术。设计:回顾性分析的推荐白人和黑人患者的关系模式心脏外科医生的质量,测量外科医生的风险调整后的死亡率(RAMR)和特征医生提供大部分的心脏保健在手术之前。不同的医生被称为外科医生患者相比使用t和配对t。模型估计测试假设影响医生的特点低质量的外科医生推荐的黑人。提取方法:变量建立了从医疗保险索赔。微分为白色和外科医生的质量黑色部分是由于医生的病人之前提供的大多数心脏保健手术。在推荐within-physician变异。医生特征调查,只有许多黑人患者CABG和引用所有心脏推荐相同的百分比医院减少外科医生”的差异白人和黑人之间的质量。几种不同的途径使黑人心脏低质量的外科医生。需要理解的原因和通知政策旨在减少之间的差距获得高质量的供应商。

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