Many studies have shown that racial and ethnic minorities consistently receive fewer referral-sensitive procedures—that is, procedures that usually require referral from a primary care physician (PCP). Typical referral-sensitive (elective or nonemergency) surgeries range from hip or joint replacements to pacemaker insertion. Minorities, especially blacks, are more likely to receive these high-cost surgical procedures when there is a high density of PCPs in their area, according to researchers at the Agency for Healthcare Research and Quality.
Increased PCP density may significantly narrow the racial disparity and improve the referral process for these procedures for minorities, according to Jayasree Basu, Ph.D., of AHRQ's Center for Primary Care Research, and Carolyn Clancy, M.D., director of AHRQ's Center for Outcomes and Effectiveness Research. The researchers examined 1995 hospital discharge files for nonelderly adult New York residents, who were hospitalized either in New York or in one of three nearby States. They linked the discharge data to county census data and hospital survey files to compare the effect of PCP supply on referral-sensitive hospital admissions versus marker admissions (urgent and insensitive to primary care, for example, heart attack or hip fracture) for whites, blacks, and Hispanics.
Black adults from high PCP-density areas had a 25 percent higher rate of referral-sensitive admissions per 1,000 adult black population of the area than those from low-PCP areas. In contrast, high PCP density was not associated with more referral-sensitive admissions for whites or Hispanics.
At the mean PCP level of the county (0.58 per 1,000 relevant population), blacks were 27 percent and Hispanics were 25 percent less likely than whites to be hospitalized for referral-sensitive admissions compared with marker admissions. However, an addition of one PCP per 1,000 population (a three-fold increase in PCP density) would result in a 102 percent increase in the odds of referral-sensitive admissions among blacks, 64 percent among Hispanics, and 36 percent among whites, relative to marker admissions.
More details are in "Racial disparity, primary care, and specialty referral," by Drs. Basu and Clancy, in the December 2001 Health Services Research 36(6), Part II.
Reprints (AHRQ Publication No. 02-R036) are available from the AHRQ Publications Clearinghouse and AHRQ InstantFax.