Racial profiling: the unintended consequences of coronary artery bypass graft report cards.
BACKGROUND
Although public release of quality information through report cards is intended to improve health care, there may be unintended consequences of report cards, such as physicians avoiding high-risk patients to improve their ratings. If physicians believe that racial and ethnic minorities are at higher risk for poor outcomes, report cards could worsen existing racial and ethnic disparities in health care.


RESULTS
To investigate the impact of New York's CABG report card on racial and ethnic disparities in cardiac care, we estimated differences in the use of CABG, PTCA, and cardiac catheterization between white versus black and Hispanic patients hospitalized for acute myocardial infarction in New York before and after New York's first CABG report card was released, adjusting for patient and hospital characteristics and national changes in racial and ethnic disparities in cardiac care. The racial and ethnic disparity in CABG use significantly increased in New York immediately after New York's CABG report card was released, whereas disparities did not change significantly in the comparison states. There was no differential change in racial and ethnic disparities between New York and the comparison states in the use of cardiac catheterization or PTCA after the CABG report card was released. Over time, this increase in racial and ethnic disparities decreased to levels similar to those before the release of report cards.


CONCLUSIONS
The release of CABG report cards in New York was associated with a widening of the disparity in CABG use between white versus black and Hispanic patients.
Werner
Rachel M
RM
Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pa, USA. rwerner@wharton.upenn.edu
Asch
David A
DA
Polsky
Daniel
D
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D003258:Consumer Behavior; D001026:Coronary Artery Bypass / Q000523:psychology / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000208:ethnology* / Q000601:surgery / Q000628:therapy; D009518:New York / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D010820:Physicians / Q000523:psychology* / Q000592:standards / Q000706:statistics & numerical data; D011287:Prejudice; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data