Racial Minority Patients Research Articles

Abstract 11119: Racial and Ethnic Disparities in Preoperative Characteristics and Outcomes Following Mitral and Tricuspid Valve Surgery

Introduction: Prior investigations assessing the impact of race and ethnicity on outcomes after mitral valve surgery have reported conflicting findings. The aim of this analysis was to examine the association of race with characteristics and outcomes for patients undergoing mitral and tricuspid valve (MV; TV) surgery using a representative statewide database. Methods: We performed retrospective analyses on 5,929 patients (2,707 female, median age 63 yrs) who underwent MV ( n =4,490, 76%), TV ( n =473, 8%), or both MV and TV ( n =966, 16%) surgery in a statewide collaborative of 10 centers from 2012-2020. The influence of race/ethnicity on preoperative characteristics, MV and TV repair rates, and postoperative outcomes was assessed for White ( n =4,208, 71%), Black ( n =1,261, 21%), Hispanic ( n =140, 2%), Asian ( n =169, 3%), and mixed/other race ( n =151, 3%) patients. Results: Black patients, compared to White patients, had a higher Society of Thoracic Surgeons predicted risk of morbidity or mortality (24.5% vs 13.1% P <0.001) with a higher incidence of previous valve operations, myocardial infarction, stroke, hypertension, diabetes, and chronic lung disease. Compared to White patients, Black and Hispanic patients were less likely to undergo an elective procedure (White 71%, Black 55%, Hispanic 58%, P <0.001). Degenerative MV disease was more prevalent in White patients (White 62%, Black 41%, Hispanic 43%, Asian 51%, mixed/other 45%, all P <0.05) while rheumatic disease was more prevalent in non-White patients (Asian 28%, Hispanic 26%, mixed/other 25%, Black 17%, White 10%, all P <0.05). Repair for degenerative MV disease was more prevalent in White vs Black patients (84% vs 74%, P <0.001), but after multivariable adjustment race was no longer associated with MV repair ( P =0.073). In multivariable analyses, adverse postoperative outcome incidences were not different by race groups, including mortality. Conclusions: Patient race/ethnicity affects the burden of comorbidities at the time of presentation for operation and MV disease etiology. Strategies to improve early detection and referral for surgery and to decrease rates of rheumatic disease for racial and ethnic minority patients with MV and TV disease may enhance outcomes.

Disparities in disposition from trauma centers to inpatient psychiatric treatment in a national sample of patients with self-inflicted injury

BackgroundSurgery providers are integral to the treatment of patients with self-inflicted injuries. Patient disposition (eg, home, inpatient psychiatric treatment, rehabilitation) is important to long-term outcomes, but little is known about factors influencing disposition after discharge following traumatic self-inflicted injury. We tested whether patient or injury characteristics were associated with disposition after treatment for self-inflicted injury. MethodsNational Trauma Data Bank query for self-inflicted injuries from 2010 to 2018. ResultsThere were 77,731 patients treated for self-inflicted injuries during the study period. Discharge home was the most common disposition (45%), and those without insurance were less likely to discharge to inpatient psychiatric treatment than those with insurance. Racial minority patients were less likely to discharge to inpatient psychiatric treatment (18.9%) than nonminority patients (23.8%, P < .001). Additionally, patients discharged to inpatient psychiatric treatment had significantly lower injury severity score (7.24 ± 7.5) than those who did not (8.69 ± 9.1, P < .001). ConclusionRacial/ethnic minority patients and those without insurance were significantly less likely to discharge to an inpatient psychiatric facility after treatment at a trauma center for self-inflicted injury. Future research is needed to evaluate the internal factors (eg, trauma center practices) and external factors (eg, inpatient psychiatric facilities not accepting patients with wound care needs) driving disposition variability.

Racial and ethnic differences in barriers to care among US adults with chronic inflammatory skin diseases: A cross-sectional study of the All of Us Research Program

Research on racial and ethnic differences in barriers to care among patients with chronic inflammatory skin diseases (CISDs) is limited. To investigate the prevalence of a broad range of barriers to care among patients with CISDs across different racial and ethnic groups. A cross-sectional study was conducted using survey data from participants with CISDs in the All of Us Research Program. Multivariable regression was used to analyze the relationship between race and ethnicity and experiencing barriers to care. Our study included 16,986 patients with CISDs. Compared to White patients, Black and Hispanic patients were significantly more likely to delay care because of cost and a broad range of additional structural barriers, including transportation, work, childcare, adult care, living in a rural area, and the lack of health care workforce diversity. However, associations between race and ethnicity and many barriers to care were substantially attenuated after controlling for insurance, income, and education. The population studied was not a representative sample of US adults, and responses were not specific to dermatologic care. Racial and ethnic minority patients with CISDs, especially Black and Hispanic patients, are disproportionately affected by a broad range of barriers to care.

S502 Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis

Introduction: Differences in EoE presentation or treatment response by ethnic or racial minority status remains understudied. We aimed to determine whether EoE patients of Hispanic/Latinx ethnicity or non-white race have differences in presentation at diagnosis or response to topical corticosteroid (tCS) treatment. Methods: We conducted a retrospective cohort study of the UNC EoE Clinicopathologic database with subjects of any age with a new diagnosis of EoE. Ethnicity and race were recorded as documented in the chart. For the subset who had treatment with a tCS and a follow-up endoscopy/biopsy, we assessed histologic response (< 15 eosinophils/hpf), global symptom response, endoscopic response, EREFS, and an endoscopic severity score (ESS). Hispanic EoE patients were compared to non-Hispanics at baseline, and before and after treatment. The same analyses were repeated for white vs non-whites. Results: Of 1026 EoE patients with ethnicity data, 23 (2%) were Hispanic and most clinical features at presentation were similar to non-Hispanic EoE patients. Out of 466 patients who received tCS, 8 were Hispanic and had numerically higher eosinophil counts (47.0 vs 24.5; p=0.09) and numerically lower histologic response (38% vs 57%; p=0.27) post-treatment. When comparing EoE patients in terms of race, non-white patients (13%) had many differences in presentation: younger age at diagnosis, less insurance, shorter symptom duration, more vomiting, less dysphagia and food impaction, fewer typical endoscopic features, and less dilation. On multivariate analyses, age, vomiting, and furrows remained independently associated with non-white race. Of 475 patients with race data treated with tCS, the 49 non-whites had a significantly lower histologic response rate (41% vs 59%; p=0.01) (Table). After controlling for age, insurance, symptom length prior to diagnosis, total steroid dose, and whether dilation was performed, non-whites were less than half as likely to have histologic response (aOR 0.42, 95%CI: 0.21-0.83). Conclusion: Only 2% of EoE patients at our center were Hispanic, and they had similar clinical presentations as non-Hispanics. While treatment response was lower, this assessment was limited by a small sample size. The non-white EoE group was larger (13%), and presentation was less dysphagia-specific. Non-white patients also had a lower histologic response to tCS which persisted after accounting for differences in presentation.

Evaluating factors contributing to low rates of breast cancer clinical trial accrual in a diverse patient population.

100 Background: In an ideal world, the populations studied in cancer clinical trials (CCT) would be representative of the patients seen in clinic. Unfortunately, significant disparities exist in trial enrollment. Patients who are white, male, insured, or of high socioeconomic status (SES) are overrepresented in NCI-sponsored CCT. Despite data indicating equal willingness for participation in CCT across all racial groups, lack of access, cultural barriers, and social determinants of health contribute to poor accrual rates among racial and ethnic minority patients. The Dan L. Duncan Comprehensive Cancer Center (DLDCCC) provides equal access to breast CCT at Smith Clinic (SC) within the safety-net Harris Health system and Baylor St. Luke’s Medical Center (BSLMC). The patient populations differ greatly at these two sites, with BSLMC serving &gt; 95% insured, largely Caucasian patients, and SC serving 60% uninsured, mostly low SES patients, with &gt; 80% racial and ethnic minorities. Despite equal access, patients at SC have a significantly higher CCT refusal rate. Methods: We performed a retrospective review of a prospectively maintained database of new patients seen at DLDCCC dating from 5/2015 to 9/2021, which included 3043 patients screened for breast CCT. 366 patients were found to be eligible for CCT. Some patients were eligible for multiple CCT, so there were 431 total offers of CCT. We performed logistic regression to evaluate whether differences in age, clinic, race, trial type, and primary language may be underlying the observed differences in CCT enrollment rates. Results: In the BSLMC cohort, 61% (116/204) of eligible patients enrolled in a CCT, while in the SC cohort only 39% (74/227) of eligible patients elected to enroll in CCT. This difference was significant on univariate but not multivariate analysis. There were significant differences when comparing race and trial type in the overall patient set. On univariate analysis, SC patients, African American (AA) patients, Hispanic/Latino patients, and Spanish speaking patients were significantly more likely to decline CCT participation. However, on multivariate analysis, only the AA patient category was associated with enrollment refusal (odds ratio 0.261, 95% CI 0.116-0.563, p &lt; 0.001). On both univariate and multivariate analyses, patients were significantly more likely to accept biobanking trials (multivariate: odds ratio 12.799, 95% CI 3.777-61.403, p &lt; 0.001). Conclusions: Based on these findings, it is likely an oversimplification to assume that equal access will lead to a complete elimination of CCT disparities. Our AA patients were significantly less likely to agree to participate in clinical trials, challenging the commonly held view that lack of access is a major barrier. We are exploring interventions designed to improve our AA patient population’s views of trial enrollment.

Enrollment patterns and site-level predictors of Black participant recruitment to a multisite randomized clinical trial (RCT) of endocrine therapy adherence support.

68 Background: Accrual of racial and ethnic minority patients (pts) to clinical trials has been an ongoing challenge in research. Barriers exist at many levels of engagement including trial availability, screening biases, strict enrollment criteria, and structural racism. Lack of trial diversity has led to less generalizable medical evidence, suboptimal data for toxicity and efficacy of cancer treatments, poorer outcomes and continued mistrust by communities of color in research processes that exclude or marginalize them. Site factors and study design strategies associated with successful recruitment of diverse study populations are understudied. Methods: Alliance A191901 is an RCT testing combinations of text and telephone support to promote endocrine therapy adherence among breast cancer survivors. It oversamples Black participants and those &lt; 50 years at thresholds of 30% each. Administrative enrollment data was used to track and describe monthly accrual trajectory by race among the initial 50% of participants (n = 590) and to examine associations between % Black participants accrued and accruing site characteristics, including site type, geographic region, % Black population in the site’s zip code and volume of pts by race accrued to recent (2018-2019) Alliance trials, using χ2 tests. We also examined patterns of Black participant accrual before and after closure of the A191901 study to non-Black participants. Results: At 50% accrual, 124 sites had enrolled at least 1 participant. Among 590 participants, 9.7% were Black and 22.5% were &lt; 50 years. Neither site type nor volume was associated with % Black participants recruited. Sites in the South recruited higher proportions of Blacks (19.0% vs 5.6% for Midwest, the lowest region, p &lt; 0.001). Neighborhood racial composition was positively associated with accrual of Black participants (17.2% at sites from highest Black composition vs. 2.3% in lowest, p &lt; 0.001). Recruitment trajectories of Black participants consistently lagged those of non-Black participants in the first half of the study; however, Black participants recruited per month numerically increased after the study reached target accrual of non-Blacks and closed to non-Black participants. Conclusions: Sites in neighborhoods and geographic regions with larger Black populations recruited higher proportions of Black participants, but site type and volume were not associated with recruitment of Black participants. Closure of non-Black study strata based on predetermined accrual targets may positively impact recruitment trajectories of Black participants, but further study is needed. Site selection based on neighborhood composition and geography may be an appropriate tool for increasing trial diversity. Support: UG1CA189823. Clinical trial information: NCT04379570.

Drivers of palliative care and hospice use among patients with advanced lung cancer.

79 Background: Despite rigorous evidence of improved quality of life and longer survival, disparities in the utilization and quality of palliative and hospice care persist for racial and ethnic minority (Black and Latinx) patients with advanced lung cancer. To better understand drivers of palliative care and hospice inequities, this study evaluated the impact of psychosocial factors (e.g., lung cancer beliefs) on palliative and hospice care utilization among minority patients with cancer. Methods: This was a prospective cohort study of 99 patients with advanced lung cancer recruited at the Mount Sinai Hospital. At enrollment, minority and non-minority patients were asked questions about their sociodemographic, clinical, and the following psychosocial factors: medical mistrust, lung cancer beliefs, palliative care and hospice beliefs. Palliative care and hospice care utilization was abstracted from patients’ medical records. Bivariate analysis examined the association between independent factors (e.g., sociodemographic, lung cancer beliefs) and outcomes of palliative care consult and hospice care use (yes vs. no). Results: Of the 99 enrolled participants, 55 (55%) were minorities with a mean age of 65 years. 42% completed a palliative care consult and 26% utilized hospice care (26%). Palliative care utilization was associated with more favorable beliefs toward palliative care (p = 0.022) and hospice (p = 0.005) and lower levels of medical mistrust (p = 0.007). Majority of the sample was not refered to palliative (50%) or hospice care (61%); however patients refered were more likely to utilize care (p &lt; 0.001). Minority patients were more likely to receive a referral and schedule a palliative care consultation compared to non-minorities (p &lt; 0.001). Self-reported minority status did not predict differences in hospice care use. Conclusions: Minority patients with lung cancer were more likely to receive a palliative care referral and specialty level consultation when compared to non-minority patients. Higher levels of mistrust were a driver of not receiving palliative care. Patient referrals appear to be an important leverage point to help mitigate disparities in palliative and hospice care use. Future work to understand factors associated with palliative care use and the impact on minority patients is needed.

219 Socioeconomic and Racial/Ethnic Disparities in Out-of-Hospital Pain Management for Patients With Long Bone Fractures

Racial and ethnic minority patients are less likely to receive analgesia in the out-of-hospital setting compared to their White counterparts. It is unknown whether these disparities persist among patients encountered by emergency medical services (EMS) with objective injuries taking socioeconomic and encounter characteristics in context. Our objective was to evaluate for socioeconomic and racial/ethnic disparities in out-of-hospital pain management among EMS-transported adults diagnosed with long bone fractures.

Consumer Assessment of Healthcare Providers and Systems Among Racial and Ethnic Minority Patients With Alzheimer Disease and Related Dementias

Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures have been used widely to measure patient-centered care. Evidence is needed to understand CAHPS measures among racial and ethnic minority patients with Alzheimer disease and related dementias (ADRD). To examine racial and ethnic disparities in CAHPS among patients with ADRD and to examine the association between social determinants of health and CAHPS disparities. This study focused on patients with ADRD who were enrolled in Medicare Shared Savings Program Accountable Care Organizations (ACOs). The primary data sets were the 2017 Medicare Beneficiary Summary File and the beneficiary-level ACO data. The study population was limited to community-based beneficiaries who had a diagnosis of ADRD and were aged 65 years and older. Cross-sectional analyses and the decomposition approach were implemented. Data were analyzed from November 2021 to July 2022. Enrollment in a Medicare Shared Savings Program ACO. Six ACO CAHPS measures were included: getting timely care, appointments, and information; how well providers communicate; patients' rating of provider; access to specialists; health promotion and education; and shared decision-making. ACO CAHPS were continuous measures with possible ranges from 0 to 100. The summation of these 6 measures as an overall index was also created. In CAHPS measures, the term provider can include hospitals, home health care agencies, and doctors, among others. The final sample included 568 368 beneficiaries (347 783 female patients [61.2%]; 38 030 African American patients [6.69%], 6258 Asian patients [1.10%], 18 231 Hispanic patients [3.21%], and 505 849 White patients [89.0%]; mean [SD] age, 82.17 [7.95] years). Significant racial and ethnic disparities in CAHPS scores were observed. After controlling for beneficiary, hospital, and area characteristics, compared with their White counterparts, African American or Black (coefficient = -1.05; 95% CI, -1.15 to -0.95; P < .001), Asian (coefficient = -0.414; 95% CI, -0.623 to -0.205; P < .001), and Hispanic (coefficient = -0.099; 95% CI, -0.229 to 0.032; P = .14) patients with ADRD reported lower total CAHPS scores. Disparities were also observed among individual ACO CAHPS. Decomposition results showed that a proxy for social determinants of health explained 10% to 13% of disparities of ACO CAHPS between African American or Black vs White and Hispanic vs White patients with ADRD. Most of the racial and ethnic disparities, especially those between White and Asian individuals, could not be explained by the models used to analyze data. These results demonstrated significant variations in CAHPS by race and ethnicity among patients with ADRD enrolled in ACOs. Social determinants of health are critical in explaining racial and ethnic disparities. More research is needed to explain disparities in CAHPS.

Outpatient dermatology clinic half days with more women, racial minority, and younger patients generate fewer work relative value units.

Outpatient dermatology clinic half days with more women, racial minority, and younger patients generate fewer work relative value units.

34371 Differences in half day outpatient dermatology clinic total work relative value units by patient race, sex, and age

Dermatology encounters for racial minority, female, and younger patients generate fewer work relative value units (wRVU) per encounter. Longer encounters for older white males may explain differences in wRVU. We aimed to determine whether differences in wRVU by patient sociodemographics persisted after adjusting for encounter length. Adult outpatient dermatology encounters from 9/1/2016-3/31/2020 within an academic center were grouped into 4-hour clinic half days (HD). To examine associations between patient demographics and wRVUs generated per HD, we used mixed linear models adjusted for fixed effects of mean age, proportion of patients who were white, proportion male, and number of encounters and random effect of individual dermatology providers. Overall, 4341 HD were included. Encounters were with predominantly white (70.3%) and female (58.6%) patients. Half days generated a mean 12.9 wRVUs (standard deviation, 4.4) and contained a mean 8.5 (2.5) encounters. HD with all white patients were associated with 3.1 (95% CI 2.7-3.6) more wRVUs than HD with no white patients. HD with all male patients were associated with 0.83 (95% CI 0.4-1.3) more wRVUs than HD with no male patients. A 10-year increase in mean age was associated with a 0.36 (0.25-0.47) increase in wRVU. HD clinics with higher proportions of white, male, and older patients generated more wRVUs. Assuming all HD sessions were of equivalent length, encounter length did not explain why older white males generate more wRVUs per encounter. Further studies should determine if differences in wRVUs stem from undervaluation of conditions that affect racial minority, female, and younger patients.

We Should Be Asking New Questions in Research on Weight Loss Surgery for Racial Minority Patients

We Should Be Asking New Questions in Research on Weight Loss Surgery for Racial Minority Patients

Society of General Internal Medicine Position Statement on Social Risk and Equity in Medicare's Mandatory Value-Based Payment Programs.

The Affordable Care Act (2010) and Medicare Access and CHIP Reauthorization Act (2015) ushered in a new era of Medicare value-based payment programs. Five major mandatory pay-for-performance programs have been implemented since 2012 with increasing positive and negative payment adjustments over time. A growing body of evidence indicates that these programs are inequitable and financially penalize safety-net systems and systems that care for a higher proportion of racial and ethnic minority patients. Payments from penalized systems are often redistributed to those with higher performance scores, which are predominantly better-financed, large, urban systems that serve less vulnerable patient populations - a "Reverse Robin Hood" effect. This inequity may be diminished by adjusting for social risk factors in payment policy. In this position statement, we review the literature evaluating equity across Medicare value-based payment programs, major policy reports evaluating the use of social risk data, and provide recommendations on behalf of the Society of General Internal Medicine regarding how to address social risk and unmet health-related social needs in these programs. Immediate recommendations include implementing peer grouping (stratification of healthcare systems by proportion of dual eligible Medicare/Medicaid patients served, and evaluation of performance and subsequent payment adjustments within strata) until optimal methods for accounting for social risk are defined. Short-term recommendations include using census-based, area-level indices to account for neighborhood-level social risk, and developing standardized approaches to collecting individual socioeconomic data in a robust but sensitive way. Long-term recommendations include implementing a research agenda to evaluate best practices for accounting for social risk, developing validated health equity specific measures of care, and creating policies to better integrate healthcare and social services.

AACR Cancer Disparities Progress Report 2022.

AACR Cancer Disparities Progress Report 2022.

Evaluating patient risk factors associated with low rates of breast cancer clinical trial accrual.

e18547 Background: In an ideal world, the populations studied in cancer clinical trials (CCT) would be representative of the patients seen in clinic. Unfortunately, significant disparities exist in trial enrollment. Patients who are white, male, insured, or of high socioeconomic status (SES) are overrepresented in NCI-sponsored CCT. Despite data indicating equal willingness for participation in CCT across all racial groups, lack of access, cultural barriers, and social determinants of health contribute to poor accrual rates among racial and ethnic minority patients. The Dan L. Duncan Comprehensive Cancer Center (DLDCCC) notably provides equal access to breast CCT at Smith Clinic (SC) within the Harris Health system and Baylor St. Luke’s Medical Center (BSLMC). The patient populations differ greatly at these two sites, with BSLMC serving &gt; 95% insured, largely Caucasian patients, and SC serving 60% uninsured, mostly low SES patients, with &gt; 80% racial and ethnic minorities. Despite equal access, patients at SC have a significantly higher CCT refusal rate. This retrospective cohort study aims to identify predictors of CCT refusal. Methods: We performed a retrospective review of a prospectively maintained database of new patients seen at DLDCCC dating from 5/2015 to 9/2021, which included 3043 patients screened for breast CCT. 366 patients were found to be eligible for CCT. Some patients were eligible for multiple CCT, so there were 431 total offers of CCT. We performed logistic regression to evaluate whether differences in age, clinic, race, trial type, and primary language may be underlying the observed differences in CCT enrollment rates. Results: In the BSLMC cohort, 61% (116/204) of eligible patients enrolled in a CCT, while in the SC cohort only 39% (74/227) of eligible patients elected to enroll in CCT. This difference was significant on univariate but not multivariate analysis. There were significant differences when comparing race and trial type in the overall patient set. On univariate analysis, SC patients, African American (AA) patients, Hispanic/Latino patients, and Spanish speaking patients were significantly more likely to decline CCT participation. However, on multivariate analysis, only the AA patient category was associated with enrollment refusal (odds ratio 0.261, 95% CI 0.116-0.563, p &lt; 0.001). On both univariate and multivariate analyses, patients were significantly more likely to accept biobanking trials (multivariate: odds ratio 12.799, 95% CI 3.777-61.403, p &lt; 0.001). Conclusions: Based on these findings, it is likely an oversimplification to assume that equal access will lead to a complete elimination of CCT disparities. Our AA patients were significantly less likely to agree to participate in clinical trials, challenging the commonly held view that lack of access is a major barrier. We are exploring interventions designed to improve our AA patient population’s views of trial enrollment.

Barriers to Taking Medications for Systemic Lupus Erythematosus: A Qualitative Study of Racial Minority Patients, Lupus Providers, and Clinic Staff.

Underrepresented racial and ethnic minorities are disproportionately affected by systemic lupus erythematosus (SLE). Racial and ethnic minorities also have more severe SLE manifestations that require use of immunosuppressive medications, and often have lower rates of medication adherence. We aimed to explore barriers of adherence to SLE immunosuppressive medications among minority SLE patients. We conducted a qualitative descriptive study using in-depth interviews with a purposive sample of racial minority SLE patients taking oral immunosuppressants (methotrexate, azathioprine, or mycophenolate), and lupus clinic providers and staff. Interviews were audiorecorded, transcribed, and analyzed using applied thematic analysis. We grouped themes using the Capability, Opportunity, Motivation, Behavior conceptual model. We interviewed 12 SLE patients (4 adherent, 8 nonadherent) and 12 providers and staff. We identified capability barriers to include external factors related to acquiring medications, specifically cost-, pharmacy-, and clinic-related issues; opportunity barriers to include external barriers to taking medications, specifically logistic- and medication-related issues; and motivation factors to include intrinsic barriers, encompassing patients' knowledge, beliefs, attitudes, and physical and mental health. The most frequently described barriers were cost, side effects, busyness/forgetting, and lack of understanding, although barriers differed by patient and adherence level, with logistic and intrinsic barriers described predominantly by nonadherent patients and side effects described predominantly by adherent patients. Our findings suggest that interventions may be most impactful if they are designed to facilitate logistics of taking medications and increase patients' motivation while allowing for personalization to address the individual differences in adherence barriers.

Modifiers of and Disparities in Palliative and Supportive Care Timing and Utilization among Neurosurgical Patients with Malignant Central Nervous System Tumors.

Patients with primary or secondary central nervous system (CNS) malignancies benefit from utilization of palliative care (PC) in addition to other supportive services, such as home health and social work. Guidelines propose early initiation of PC for patients with advanced cancers. We analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities in access to and utilization of supportive services. We introduce a novel construct, "provider patient racial diversity index" (provider pRDI), which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider's patient demographics and suggest a provider's cultural sensitivity and exposure to diversity. Our analysis demonstrates low rates of PC, home health, and social work services among racial minority patients. Notably, Hispanic patients had low likelihood of engaging with all three categories of supportive services. However, patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses. This study suggests that prospective studies that examine potential interventions at the provider level, including diversity training, are needed.

Implicit Racial Bias in Pediatric Orthopaedic Surgery.

Racial and ethnic minority patients continue to experience disparities in health care. It is important to understand provider-level factors that may contribute to these inequities. This study aims to evaluate the presence of implicit racial bias among pediatric orthopaedic surgeons and determine the relationship between bias and clinical decision making. A web-based survey was distributed to 415 pediatric orthopaedic surgeons. One section measured for potential implicit racial bias using a child-race implicit association test (IAT). IAT scores were compared with US physicians and the US general population using publicly available data. Another section consisted of clinical vignettes with associated questions. For each vignette, surgeons were randomly assigned a single race-version, White or Black. Vignette questions were grouped into an opioid recommendation, management decision, or patient perception category for analysis based on subject tested. Vignette answers from surgeons with IAT scores that were concordant with their randomized vignette race-version (ie, surgeon with pro-White score assigned White vignette version) were compared with those that were discordant. IAT results were obtained from 119 surveyed surgeons (29% response rate). Overall, respondents showed a minor pro-White implicit bias ( P <0.001). Implicit bias of any strength toward either race was present among 103/119 (87%) surgeons. The proportion of pediatric orthopaedic surgeons with a strong pro-White implicit bias (29%) was greater than that of US physicians overall (21%, P =0.032) and the US general population (19%, P =0.004). No differences were found in overall opioid recommendations, management decisions, or patient perceptions between concordant and discordant groups. Most of the pediatric orthopaedic surgeons surveyed demonstrated implicit racial bias on IAT testing, with a large proportion demonstrating strong pro-White bias. Despite an association between implicit bias and clinical decision making in the literature, this study observed no evidence that implicit racial bias affected the management of pediatric fractures. Level IV.

Ethnic, Racial Minority Patients Don't Get Appropriate Diagnostic Imaging

Ethnic, Racial Minority Patients Don't Get Appropriate Diagnostic Imaging

Analysis of Direct-To-Consumer Healthcare Service Advertisements on Television: An Application of the Patient Expectation Framework

ABSTRACT Direct-to-consumer advertisements for healthcare services constitute a rare channel of public communication where consumers see and hear directly from their local providers and healthcare organizations. Although spending on these advertisements has increased drastically during the past decades, research on their content and effects remains rare. To fill this gap, we analyzed primetime television advertisements for healthcare services directly targeting consumers. The advertisements were collected from the two largest media markets in Nevada for one month. In total, 795 advertisements were identified, and 106 of them were non-duplicates. Analysis revealed that the advertisements focused on patients’ good health outcomes by showing them smiling, going out and about, having fun with others, and enjoying rigorous physical activities. On the other hand, the advertisements focused less on the providers. Although the advertisements often showed providers in clinical settings, basic information about their professional degrees was often missing. Mentions of providers’ other qualifications and professional experiences were even scarcer. Also, a substantial number of advertisements failed to show providers interacting with patients. Additional analysis of patient and provider characteristics revealed under-representation of racial or ethnic minority and older adult patients. Representation of women and minorities as providers was even more uncommon. We discussed the implications of these findings from the perspective of patient expectation and made suggestions to help providers improve their direct-to-consumer advertisements.