Racial disparity, primary care, and specialty referral.
OBJECTIVE
The study examines the role of primary care physicians (PCP) in reducing racial disparities in referral-sensitive admissions.


METHODS
The study examined hospital discharges of New York residents in the age group 20 to 64 hospitalized either in New York or in any of three contiguous states -- New Jersey, Pennsylvania, or Connecticut -- using complete discharge files for the four states in 1995. The discharge data were linked to the Area Resource File and the American Hospital Association's survey files for 1995.


METHODS
The study used multivariate logistic models to compare the effect of PCP supply on referral-sensitive (discretionary) admissions versus marker admissions (urgent, in sensitive to primary care) or whites, blacks, and Hispanics.


RESULTS
Compared with marker admissions, an increased PCP density in an area was associated with a higher probability of black admissions than white admissions for referral-sensitive procedures.


CONCLUSIONS
Our analysis suggests that the supply of primary care may be important for admissions for referral-sensitive procedures. Nonwhites, especially blacks, may have greater access to these procedures through increased PCP supply. Increased PCP density may significantly narrow the racial disparity in specialty referrals and improve the referral process for these procedures for nonwhites.
Basu
J
J
Center for Primary Care Research, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA.
Clancy
C
C
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D005260:Female; D020793:Gatekeeping; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D016017:Odds Ratio; D010351:Patient Discharge; D010819:Physician's Role; D010821:Physicians, Family / Q000600:supply & distribution*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D013514:Surgical Procedures, Operative / Q000145:classification / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*