Many studies have shown that minority patients are less likely to undergo coronary artery bypass graft (CABG) surgery than white patients. Even when they do gain access to CABG surgery, minority patients are more likely to have a lower quality surgeon than white patients who undergo the surgery. The disparity in the surgeon's quality was even greater for minorities enrolled in health maintenance organizations (HMOs) compared with those in fee-for-service (FFS) plans, concludes a study supported by the Agency for Healthcare Research and Quality (HS09803). The researchers defined surgeon quality based on the risk-adjusted mortality rate (RAMR) of a surgeon's patients, that is, the mortality rate of patients after adjustment for patient risk factors for death.
Dana B. Mukamel, Ph.D., of the University of Rochester Medical Center, and colleagues used regression analysis of 11,296 CABG surgeries in New York State in 1996 to identify significant associations between a patient's race, HMO enrollment, and quality of the surgeon performing the surgery. Results revealed that minorities in HMOs were 12 percent more likely and those in FFS plans were 5 percent more likely than whites to be operated on by surgeons with higher RAMR patients.
It might be that disadvantaged minorities are more likely to face barriers to accessing published RAMR report cards of New York cardiac surgeons, which are available on the World Wide Web and publicized in the media. Also, higher quality surgeons seem to have higher prices and may also locate themselves in more affluent markets, which would be less accessible to lower-income and minority individuals, hypothesize the researchers. Studies that identify why minority patients get poorer quality cardiac surgeons than white patients may help develop policy interventions to improve access to quality care for racial minorities, conclude the study authors.
See "Racial differences in access to high-quality cardiac surgeons," by Dr. Mukamel, Ananthram S. Murthy, B.A., and David L. Weimer, Ph.D., in the November 2000 American Journal of Public Health 90(11), pp. 1774-1777.