Physicians' perceptions of patients' social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease.
OBJECTIVE
A growing body of evidence suggests that provider decisionmaking contributes to racial/ethnic disparities in care. We examined the factors mediating the relationship between patient race/ethnicity and provider recommendations for coronary artery bypass graft surgery.


METHODS
Analyses were conducted with a data set that included medical record, angiogram, and provider survey data on postangiogram encounters with patients who were categorized as appropriate candidates for coronary artery bypass graft surgery.


RESULTS
Race significantly influenced physician recommendations among male, but not female, patients. Physicians' perceptions of patients' education and physical activity preferences were significant predictors of their recommendations, independent of clinical factors, appropriateness, payer, and physician characteristics. Furthermore, these variables mediated the effects of patient race on provider recommendations.


CONCLUSIONS
Our findings point to the importance of research and intervention strategies addressing the ways in which providers' beliefs about patients mediate disparities in treatment. In addition, they highlight the need for discourse and consensus development on the role of social factors in clinical decisionmaking.
van Ryn
Michelle
M
Department of Family Practice and Community Health, University of Minnesota, Room 225 Dinnaken Building, 925 Delaware Street SE, Minneapolis, MN 55414, USA. vanry001@umn.edu
Burgess
Diana
D
Malat
Jennifer
J
Griffin
Joan
J
D001291:Attitude of Health Personnel; D001026:Coronary Artery Bypass; D003657:Decision Making; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D010817:Physician-Patient Relations; D011822:Race Relations; D012307:Risk Factors; D013240:Stereotyping