Geographical distribution of surgical capabilities and disparities in the use of high-volume providers: the case of coronary artery bypass graft.
BACKGROUND
Previous studies have documented substantial differences by patient race/ethnicity and insurance in the use of high-volume surgical providers. The extent to which regional availability of surgical capabilities explains such differences has not been examined.


OBJECTIVE
To examine the existence of racial/ethnic and payer differences in using high-volume hospitals and surgeons for coronary artery bypass graft (CABG) in the state of Florida and to study the role of regional availability of high-volume providers in explaining the differences.


METHODS
We conducted descriptive analysis of the distribution of CABG providers and patient populations by race/ethnicity and insurance across the 19 Hospital Referral Regions (HRRs) in Florida. We estimated logistic regressions of using a high-volume provider to derive estimates of overall group differences. We further estimated models with HRR fixed effects to derive within-HRR differences. We derived implications by comparing findings based on the 2 sets of models.


RESULTS
Non-Hispanic black patients were 58% as likely (95% CI: 52%, 65%), Hispanic patients were 84% as likely (95% CI: 77%, 90%), to have received CABGs at a high-volume hospital, compared with non-Hispanic whites. Controlling for inter-HRR differences eliminated almost all racial/ethnic differences. Substantial differences in using high-volume providers existed between Medicaid/uninsured and privately insured patients and such differences persisted within HRRs.


CONCLUSIONS
Unequal distribution of CABG capabilities coupled with racial/ethnic concentration in residence across Florida HRRs accounted for almost all racial/ethnic differences in using high-volume hospitals. Factors other than availability of surgical resources were responsible for differences between Medicaid/uninsured and privately insured patients.
Bao
Yuhua
Y
Department of Public Health, Division of Health Policy, Weill Cornell Medical College, 402 E. 67th Street, New York, NY 10065, USA. yub203@med.cornell.edu
Kamble
Shital
S
D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data; D002568:Certification / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005431:Florida / Q000453:epidemiology; D019538:Health Care Surveys; D006276:Health Facility Size / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000458:organization & administration*; D006331:Heart Diseases / Q000208:ethnology / Q000601:surgery; D006630:Hispanic or Latino / Q000208:ethnology / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D013903:Thoracic Surgery / Q000193:education / Q000706:statistics & numerical data; D014481:United States; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data