title: Improved quality of care for cardiovascular disease for Latinos seen in high proportion Latino vs low proportion Latino clinics.
abstract: BACKGROUND
  Primary care practices that concentrate linguistically and culturally appropriate services for Latinos may result in higher cardiology consultation rates and improved process measure performance for patients with coronary artery disease (CAD) and congestive heart failure (CHF).
  
  
  METHODS
  Multivariable Cox proportional-hazards regression was used to assess differences in referral at high proportion (HP) vs low proportion (LP) practices. Multivariable Poisson regression was used to assess the frequency of follow-up consultation.
  
  
  RESULTS
  Among the 9,761 patients, 9,168 had CAD, 4,444 had CHF, and 3,851 had both conditions. Latinos comprised 11% of the CAD cohort and 11% of the CHF cohort. Multivariable analyses showed higher consultation rates for Latinos at HP practices for CAD and CHF. Blacks and Whites at HP practices had no significant differences in rates of consultation compared to those in LP practices. Latinos at HP practices had 25% more consultations for CAD and 23% more consultations for CHF than Latinos at LP practices. Latinos at HP clinics had higher overall mean quality performance on clinical measures for both CAD and CHF. Latinos at an LP clinic had the largest improvement in quality performance with consultation.
  
  
  CONCLUSIONS
  Among Latinos with CAD or CHF receiving care within a single large academic care network, Latino patients at HP practices have higher rates of cardiologist consultation and performance on CVD process measures compared to Latino patients at LP practices. Elucidating the essential components of individual practice environments that provide higher quality of care for Latinos will allow for well designed systems to reduce health care disparities.
authors: Lenny
authors: L
authors: López
authors: Nakela
authors: N
authors: Cook
authors: Leroi
authors: L
authors: Hicks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000208:ethnology / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D006333:Heart Failure / Q000208:ethnology / Q000628:therapy*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014481:United States