Abstract
Background: Black patients have worse ischemic heart disease (IHD) outcomes than White patients. How healthcare provider team segregation, dissimilarity/distinctiveness in the composition of provider teams caring for Black vs White patients within a hospital, contributes to racial inequities in IHD outcomes is unclear. Methods: Using Optum’s de-identified Clinformatics® Data Mart of commercial and Medicare beneficiaries, we identified non-Hispanic Black and White patients with an admission diagnosis of IHD from 2010-2018. We calculated the Segregation Index (SI, 0 - 1; 0 for similarity/complete overlap; 1 for lack of similarity/overlap in the composition of provider teams caring for Black vs White patients). Hospitals were stratified into tertiles with increasing dissimilarity between provider care teams [low (0.16-0.38), medium (≥0.39-0.48), and high (≥0.49-0.97)]. For 30-day readmission, we used generalized linear mixed-effects models including effects of race, SI tertile, race-SI, gender, age-adjusted Charlson Comorbidity Index, and hospital factors including effects of cardiology care, 2-way, and 3-way interactions of race, SI, and cardiology care. Results: Among 183,165 patients with IHD, odds of 30-day readmission were similar by race across SI tertiles in the absence of cardiology care. With cardiology care, Black patients in low and medium SI tertiles had higher odds of 30-day readmission than White patients [low: OR 1.08 (95% CI 1.02 - 1.13); medium: OR 1.12 (95% CI 1.04 - 1.21)] but not the high SI tertile [OR 1.03 (95% CI 0.93 - 1.14)] ( Figure ). Conclusions: Among patients with IHD seen by a cardiologist, for 30-day readmission there was a significant racial disparity in favor of White patients seen at hospitals with lower levels of provider team segregation. Further research is needed to investigate the causes of this disparity, which may be related to preferential selection of cardiologists among commercial and Medicare insured populations.
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