title: Drivers of Racial and Ethnic Disparities in Cardiac Rehabilitation Use: Patient and Provider Perspectives.
abstract: Cardiac rehabilitation (CR) use is lower for racial and ethnic minorities than White patients. The purpose of this study was to identify factors that drive this disparity at the system, provider, and patient levels. A mixed methods study combined descriptive analysis of 2007 Medicare claims data and thematic analysis of 19 clinician interviews, 8 minority patient focus groups and 8 one-on-one interviews with minority heart patients across three communities. The disparity between White and non-White CR use ranged from 7 to 11 percentage points among study sites (p < .05). Key themes suggest disparities are driven by (a) flawed financing and reimbursement that creates disincentives to invest in CR programs, (b) a health care system whose priorities are misaligned with the needs of patients, and (c) subjective decision-making around referral processes. These findings suggest that the health care system needs to address multiple levels of problems to mitigate disparities in CR use.
authors.affiliation: George Washington University, Washington, DC, USA khmead@gwu.edu.
authors.forename: Holly
authors.initials: H
authors.lastname: Mead
authors.affiliation: Urban Institute, Washington, DC, USA.
authors.forename: Christal
authors.initials: C
authors.lastname: Ramos
authors.affiliation: Center for Consumer Information and Insurance Oversight, Bethesda, MD, USA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Grantham
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology* / Q000706:statistics & numerical data; D061889:Healthcare Financing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012051:Reimbursement Mechanisms; D014481:United States
keywords: cardiac rehabilitation; disparities; health care delivery system