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Titolo:
Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery
Autore:
Hannan, EL; van Ryn, M; Burke, J; Stone, D; Kumar, D; Arani, D; Pierce, W; Rafii, S; Sanborn, TA; Sharma, S; Slater, J; DeBuono, BA;
Indirizzi:
SUNY,Albany, Sch Publ Hlth, Dept Hlth Policy Management & Behav, Rensselaer SUNY Albany Rensselaer NY USA 12144 Policy Management & Behav, Rensselaer SUNY Buffalo, Buffalo, NY 14260 USA SUNY Buffalo Buffalo NY USA 14260SUNY Buffalo, Buffalo, NY 14260 USA Buffalo Gen Hosp, Buffalo, NY 14203 USA Buffalo Gen Hosp Buffalo NY USA 14203 alo Gen Hosp, Buffalo, NY 14203 USA Brooklyn Hosp Ctr, Brooklyn, NY USA Brooklyn Hosp Ctr Brooklyn NY USABrooklyn Hosp Ctr, Brooklyn, NY USA Brookdale Hosp, Brooklyn, NY USA Brookdale Hosp Brooklyn NY USABrookdale Hosp, Brooklyn, NY USA Cornell Univ, Med Ctr, New York Hosp, New York, NY 10021 USA Cornell UnivNew York NY USA 10021 New York Hosp, New York, NY 10021 USA Mt Sinai Med Ctr, New York, NY 10029 USA Mt Sinai Med Ctr New York NY USA10029 ai Med Ctr, New York, NY 10029 USA St Lukes Roosevelt Hosp, New York, NY 10025 USA St Lukes Roosevelt Hosp New York NY USA 10025 osp, New York, NY 10025 USA New York State Dept Hlth, Albany, NY USA New York State Dept Hlth Albany NY USA k State Dept Hlth, Albany, NY USA
Titolo Testata:
MEDICAL CARE
fascicolo: 1, volume: 37, anno: 1999,
pagine: 68 - 77
SICI:
0025-7079(199901)37:1<68:ATCABS>2.0.ZU;2-8
Fonte:
ISI
Lingua:
ENG
Soggetto:
NEW-YORK-STATE; ACUTE MYOCARDIAL-INFARCTION; OF-VETERANS-AFFAIRS; CARDIAC PROCEDURES; HEART-DISEASE; GRAFT-SURGERY; RACE; ANGIOGRAPHY; SYSTEM; RATES;
Keywords:
CABG surgery; race and gender access; appropriateness; bypass surgery;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Social & Behavioral Sciences
Clinical Medicine
Citazioni:
34
Recensione:
Indirizzi per estratti:
Indirizzo: Hannan, EL SUNY Albany, Sch Publ Hlth, Dept Hlth Policy Management & Behav, 1 Univ Pl, SUNY Albany 1 Univ Pl Rensselaer NY USA 12144 Behav, 1 Univ Pl,
Citazione:
E.L. Hannan et al., "Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery", MED CARE, 37(1), 1999, pp. 68-77

Abstract

OBJECTIVE. The study sought to determine if there were race/ethnicity or gender differences in access to coronary artery bypass graft (CABG) surgery among patients who have been designated as appropriate and as necessary forthat surgery according to the RAND methodology. METHODS. RAND appropriateness and necessity criteria were used to identifya race/gender stratified sample of postangiography patients who would benefit from coronary artery bypass graft surgery. These patients were tracked for 3 months to determine if they had undergone coronary artery bypass graft surgery in New York State. Subjects were a total of 1,261 postangiographypatients in eight New York hospitals in 1994 to 1996. Measures included percentages of patients for whom coronary artery bypass graft surgery was appropriate and necessary undergoing surgery by race/ethnicity and gender, as well as multivariate odds ratios for race/ethnicity and gender. RESULTS. After controlling for age, payer, number of vessels diseased, andpresence of left main disease, African-American and Hispanic patients werefound to be significantly less likely to undergo coronary artery bypass graft surgery than white non-Hispanic patients (respective odds ratios 0.64 and 0.60). When "necessity" was used as a criterion instead of "appropriateness," significant differences in access for African-American patients remained. The gatekeeper physician recommended surgery only 10% of the time thatpatients did not undergo "appropriate" coronary artery bypass graft surgery, and this percentage did not vary significantly by race/ethnicity or gender of the patient. CONCLUSIONS. Even after controlling for appropriateness and necessity for coronary artery bypass graft surgery in a prospective study, African-American patients had significant access problems in obtaining coronary artery bypass graft surgery. These problems appeared not to be related to patient refusals.

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Documento generato il 26/11/20 alle ore 08:42:56