Background:Studies have shown that Black patients die more frequently following coronary artery bypass grafting than their White counterparts for reasons not fully explained by disease severity or comorbidity. To examine whether provider care team segregation within hospitals contributes to this inequity, we analyzed national Medicare data.Methods:Using national Medicare data, we identified beneficiaries who underwent coronary artery bypass grafting at hospitals where this procedure was performed on at least 10 Black and 10 White patients between 2008 and 2014 (n=12 646). After determining the providers who participated in their perioperative care, we examined the extent to which Black and White patients were cared for by unique networks of provider care teams within the same hospital. We then evaluated whether a lack of overlap in composition of the provider care teams treating Black versus White patients (ie, high segregation) was associated with higher 90-day operative mortality among Black patients.Results:The median level of provider care team segregation was high (0.89) but varied across hospitals (interquartile range, 0.85–0.90). On multivariable analysis, after controlling for patient-, hospital-, and community-level differences, mortality rates for White patients were comparable at hospitals with high and low levels of provider care segregation (5.4% [95% CI, 4.7%–6.1%] versus 5.8% [95% CI, 4.7%–7.0%], respectively; P=0.601), while Black patients treated at high-segregation hospitals had significantly higher mortality than those treated at low-segregation hospitals (8.3% [95% CI, 5.4%–12.4%] versus 3.3% [95% CI, 2.0%–5.4%], respectively; P=0.017). The difference in mortality rates for Black and White patients treated at low-segregation hospitals was nonsignificant (−2.5%; P=0.098).Conclusions:Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.

中文翻译：

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冠状动脉旁路移植术后提供者护理团队的隔离和手术死亡率

背景：研究表明，黑人患者在冠状动脉旁路移植术后比白人患者更容易死亡，其原因不能完全用疾病严重程度或合并症来解释。为了检查医院内提供者护理团队的隔离是否会导致这种不平等，我们分析了国家医疗保险数据。方法：使用国家医疗保险数据，我们确定了在至少 10 名黑人和 10 名黑人接受过冠状动脉搭桥术的医院接受过冠状动脉搭桥术的受益人。 2008 年至 2014 年期间的白人患者 (n=12 646)。在确定参与围手术期护理的提供者之后，我们检查了同一医院内独特的提供者护理团队网络对黑人和白人患者的护理程度。然后，我们评估了治疗黑人与白人患者的提供者护理团队的组成缺乏重叠（即高度隔离）是否与黑人患者较高的 90 天手术死亡率相关。 结果：提供者护理团队隔离的中位水平为高 (0.89)，但不同医院之间存在差异（四分位数范围，0.85–0.90）。在多变量分析中，在控制了患者、医院和社区层面的差异后，在提供者护理隔离程度高和低的医院中，白人患者的死亡率具有可比性（5.4% [95% CI，4.7%–6.1%） ] 与 5.8% [95% CI，4.7%–7.0%]；P = 0.601），而在高种族隔离医院接受治疗的黑人患者的死亡率显着高于在低种族隔离医院接受治疗的黑人患者（8.3% [95%]分别为 CI，5.4%–12.4%] 与 3.3% [95% CI，2.0%–5.4%]；P =0.017）。在低隔离医院接受治疗的黑人和白人患者的死亡率差异不显着（−2.5%；P = 0.098）。结论：在提供护理团队隔离水平较高的医院接受冠状动脉旁路移植术的黑人患者与在较低级别医院接受治疗的黑人患者相比，手术后死亡的频率更高。