National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 18 of 18 Research Studies DisplayedBonner SN, Powell CA, Stewart JW
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
The purpose of this review was to explore effective interventions to reduce inequities and identify gaps in intervention-based research with a goal of increasing awareness of surgeons, surgical trainees, researchers, and policy makers of the evidence-based interventions known to reduce racial and ethnic disparities in surgical care for prioritization of resource allocation and implementation. The researchers reviewed the PubMed database for English-language studies published from January 2012 through June 2022 to evaluate interventions to reduce or eliminate racial and ethnic disparities in surgical care. A narrative review of literature was conducted identifying interventions that have been related with reduction in racial and ethnic disparities in surgical care. The study found that attaining surgical equity will necessitate implementing evidence-based interventions to improve quality for racial and ethnic minorities, prioritizing funding for intervention-based research, utilizing implementation science and community based-participatory research methods, and principles of learning health systems.
AHRQ-funded; HS026030.
Citation: Bonner SN, Powell CA, Stewart JW .
Surgical care for racial and ethnic minorities and interventions to address inequities: a narrative review.
Ann Surg 2023 Aug 1; 278(2):184-92. doi: 10.1097/sla.0000000000005858..
Keywords: Racial and Ethnic Minorities, Disparities, Surgery
Iantorno SE, Ulugia JG, Kastenberg ZJ
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
This retrospective cohort study sought to explore whether racial and ethnic disparities for children presenting with acute appendicitis persist after initial management and hospital discharge. The cohort included children under 18 years who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals from 2017 to 2019. Findings showed that children of racial and ethnic minorities were more likely to visit the emergency department after treatment for acute appendicitis, but Hispanic/Latinx patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Ulugia JG, Kastenberg ZJ .
Postdischarge racial and ethnic disparities in pediatric appendicitis: a mediation analysis.
J Surg Res 2023 Feb;282:174-82. doi: 10.1016/j.jss.2022.09.027..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Disparities, Hospital Discharge, Surgery
Shen MR, Jiang S, Millis MA
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
The purpose of this study was to examine whether differences exist in baseline characteristics or access to care between white and non-white patients of bariatric surgery. The researchers utilized a statewide bariatric-specific data registry and assessed all patients of bariatric surgery who completed a baseline questionnaire prior to the operation and compared data among racial groups. A total of 73,141 patients were included with 25.5% self-identifying as non-white. Non-white males were the least represented group with 4% of all bariatric surgery cases performed. Despite having higher rates of college education, when compared to white patients non-white patients were more likely to be younger, disabled, and have Medicaid. Despite having higher rates of patients with a body mass index above 50 kg/m the median time from the first evaluation to surgery was longer among non-white patients (157 days vs. 127 days.) The study concluded that despite presenting with higher rates of severe obesity, when compared with white patients non-white patients of bariatric surgery are an extremely diverse group with greater socioeconomic disadvantages and longer wait times.
AHRQ-funded; HS000053.
Citation: Shen MR, Jiang S, Millis MA .
Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery.
Surg Endosc 2023 Jan; 37(1):564-70. doi: 10.1007/s00464-022-09292-w..
Keywords: Racial and Ethnic Minorities, Surgery, Obesity: Weight Management, Obesity, Disparities
Anjorin AC, Marcaccio CL, Patel PB
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
This study’s objective was to determine the differences in 3-year outcomes after open infrainguinal bypass for chronic limb-threatening ischemia (CLTI) stratified by race/ethnicity and explored the potential factors contributing to these differences to help determine reasons why outcomes are worse for racial and ethnic minorities. The authors identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. They also recorded 30-day major adverse limb events (MALE) defined as major amputation or reintervention. Of the 7108 patients with CLTI 79% were non-Hispanic White, 15% were Black, 1% were Asian, and 6% were Hispanic. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%), reintervention (Black vs White, 61% vs 57%), and 30-day MALE (Black vs White, 8.1% vs 4.9%) but lower mortality (Black vs White, 38% vs 42%). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%), reintervention (Hispanic vs White, 70% vs 57%), and MALE (Hispanic vs White, 8.7% vs 4.9%). However, mortality was similar between Hispanic vs White groups. A higher presence of comorbidities in Black and Hispanic patients with CLTI is considered the greatest contributing factors to higher amputation and reintervention rates.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Patel PB .
Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.
J Vasc Surg 2022 Nov;76(5):1335-46.e7. doi: 10.1016/j.jvs.2022.06.026..
Keywords: Racial and Ethnic Minorities, Disparities, Outcomes, Surgery, Cardiovascular Conditions
Herb J, Staley BS, Roberson M
Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population.
The investigators’ objective was to determine national usage and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism among insured older adults. Data was obtained using Medicare claims. They found that parathyroidectomy was underused and recommended that quality improvement efforts, rooted in equitable care, be undertaken to increase access to parathyroidectomy for this disease.
AHRQ-funded; HS000032.
Citation: Herb J, Staley BS, Roberson M .
Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population.
Surgery 2021 Nov;170(5):1376-82. doi: 10.1016/j.surg.2021.05.026..
Keywords: Elderly, Disparities, Medicare, Surgery, Racial and Ethnic Minorities
Purnell TS, Simpson DC, Callender CO
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
As the United States faces unparalleled challenges due to COVID-19, racial disparities in health and healthcare have once again taken center stage. If effective interventions to address racial disparities in transplantation, including those magnified by COVID-19, are to be designed and implemented at the national level, it is first critical to understand the complex mechanisms by which structural, institutional, interpersonal, and internalized racism influence the presence of racial disparities in healthcare and transplantation. IN this article the authors discuss their viewpoint.
AHRQ-funded; HS024600.
Citation: Purnell TS, Simpson DC, Callender CO .
Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation.
Am J Transplant 2021 Jul;21(7):2327-32. doi: 10.1111/ajt.16543..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Transplantation, Surgery, Access to Care
Dos Santos Marques IC, Theiss LM, Wood LN
Racial disparities exist in surgical outcomes for patients with inflammatory bowel disease.
The authors hypothesized that racial disparities exist for Hispanic and Asian patients undergoing surgery for inflammatory bowel disease (IBD). Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS- NSQIP) was used. They found that racial disparities do exist among IBD patients undergoing surgery. Black, Hispanic, and Asian IBD patients experience major disparities in post-operative complications, readmissions, and length of stay, respectively, when compared to White patients with IBD. They recommended future research to better understand the mechanisms of these disparities including evaluation of social determinants of health.
AHRQ-funded; HS023009.
Citation: Dos Santos Marques IC, Theiss LM, Wood LN .
Racial disparities exist in surgical outcomes for patients with inflammatory bowel disease.
Am J Surg 2021 Apr;221(4):668-74. doi: 10.1016/j.amjsurg.2020.12.010..
Keywords: Disparities, Racial and Ethnic Minorities, Surgery, Digestive Disease and Health, Outcomes
Pollack LM, Olsen MA, Gehlert SJ
Racial/ethnic disparities/differences in hysterectomy route in women likely eligible for minimally invasive surgery.
The objective of the study was to evaluate racial/ethnic variation in hysterectomy surgical route in women likely eligible for minimally invasive hysterectomy. The investigators concluded that African American, Hispanic, and Asian/PI women eligible for minimally invasive hysterectomy were more likely than White women to receive abdominal hysterectomy. In addition, the proportion of all women undergoing abdominal hysterectomy was highest at hospitals serving higher proportions of African American persons.
AHRQ-funded; HS019455; HS022330.
Citation: Pollack LM, Olsen MA, Gehlert SJ .
Racial/ethnic disparities/differences in hysterectomy route in women likely eligible for minimally invasive surgery.
J Minim Invasive Gynecol 2020 Jul-Aug;27(5):1167-77. doi: 10.1016/j.jmig.2019.09.003..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Women, Surgery
Dos Santos Marques IC, Herbey II, Theiss LM
Understanding the surgical experience for African-Americans and Caucasians with enhanced recovery.
The purpose of this study was to use qualitative methods to better understand the surgical experience for African-American and Caucasian patients in the setting of an enhanced recovery program (ERP). Findings showed that African-American and Caucasian surgical patients have varied surgical experiences even under an ERP. All patients, however, valued the ability to obtain, process, and understand health information during the surgical process. These elements define "health literacy" and suggest the importance of providing health literacy-sensitive care in surgery.
AHRQ-funded; HS023009.
Citation: Dos Santos Marques IC, Herbey II, Theiss LM .
Understanding the surgical experience for African-Americans and Caucasians with enhanced recovery.
J Surg Res 2020 Jun;250:12-22. doi: //10.1016/j.jss.2019.12.034..
Keywords: Surgery, Racial and Ethnic Minorities, Patient Experience, Disparities, Health Literacy, Education: Patient and Caregiver
Ezer N, Mhango G, Bagiella E
Racial disparities in resection of early stage non-small cell lung cancer: variability among surgeons.
This study examined racial disparities in resection surgery of non-small cell lung cancer (NSCLC). These disparities are well documented. The authors identified 19,624 patients with stage I-II NSCLC 65 years and older from the SEER-Medicare database. They studied patients evaluated by a surgeon within 6 months of diagnosis. Black patients were less likely to undergo resection with resection rates varying among surgeons. Thoracic surgeon specialists were less likely to have any disparities with resection rates.
AHRQ-funded; HS019670.
Citation: Ezer N, Mhango G, Bagiella E .
Racial disparities in resection of early stage non-small cell lung cancer: variability among surgeons.
Med Care 2020 Apr;58(4):392-98. doi: 10.1097/mlr.0000000000001280..
Keywords: Disparities, Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Surgery, Practice Patterns
Garcia RM, Prabhakaran S, Richards CT
Race, socioeconomic status, and gastrostomy after spontaneous intracerebral hemorrhage.
This study sought to determine if socioeconomic status among minorities indicates higher or lower use of a gastrostomy tube for patients with intracerebral hemorrhage. Patients at a single center were enrolled in an observational cohort study from 2010 to 2017. Zip codes were used to impute socioeconomic status. Of the 512 patients, 18.2% underwent gastrostomy tube placement. Blacks had the highest percentage of placement and Whites the lowest. Only with Hispanics was socioeconomic index independently associated with gastrostomy placement and the lower the income, the less likelihood of gastrostomy use.
AHRQ-funded; HS023437.
Citation: Garcia RM, Prabhakaran S, Richards CT .
Race, socioeconomic status, and gastrostomy after spontaneous intracerebral hemorrhage.
J Stroke Cerebrovasc Dis 2020 Feb;29(2):104567. doi: 10.1016/j.jstrokecerebrovasdis.2019.104567.
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Keywords: Social Determinants of Health, Racial and Ethnic Minorities, Surgery, Disparities
Bass AR, Mehta B, Szymonifka J
Racial disparities in total knee replacement failure as related to poverty.
The authors sought to determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Linking New York state patients to residential census tracts by geocoded addresses, they found that there was a trend toward higher TKR revision risk in blacks, but poverty did not modify the relationship between race and TKR revision or failure.
AHRQ-funded; HS016075.
Citation: Bass AR, Mehta B, Szymonifka J .
Racial disparities in total knee replacement failure as related to poverty.
Arthritis Care Res 2019 Nov;71(11):1488-94. doi: 10.1002/acr.24028..
Keywords: Disparities, Racial and Ethnic Minorities, Low-Income, Surgery, Orthopedics, Social Determinants of Health
Wahl TS, Goss LE, Morris MS
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
The purpose of this study was to investigate the effects of enhanced recovery after surgery (ERAS) on racial disparities in postoperative length of stay (pLOS) after colorectal surgery. The authors hypothesized that ERAS would reduce disparities in pLOS between black and white patients. They concluded that ERAS eliminated racial differences in pLOS between black and white patients undergoing colorectal surgery. Reduced pLOS occurred without increases in mortality, readmissions, and most postoperative complications.
AHRQ-funded; HS013852.
Citation: Wahl TS, Goss LE, Morris MS .
Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery.
Ann Surg 2018 Dec;268(6):1026-35. doi: 10.1097/sla.0000000000002307..
Keywords: Surgery, Racial and Ethnic Minorities, Disparities, Care Management, Healthcare Delivery, Hospitalization, Patient-Centered Outcomes Research, Outcomes
Adelani MA, Keller MR, Barrack RL
The impact of hospital volume on racial differences in complications, readmissions, and emergency department visits following total joint arthroplasty.
This study evaluates the impact of hospital volume on racial differences in outcomes following joint replacement. The study authors concluded that adjusting for hospital volume does not alter the risk of readmissions and ED use associated with minority race/ethnicity, suggesting that hospital volume alone may be insufficient to explain racial differences in outcome.
AHRQ-funded; HS019455.
Citation: Adelani MA, Keller MR, Barrack RL .
The impact of hospital volume on racial differences in complications, readmissions, and emergency department visits following total joint arthroplasty.
J Arthroplasty 2018 Feb;33(2):309-15.e20. doi: 10.1016/j.arth.2017.09.034..
Keywords: Disparities, Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Outcomes, Surgery
Witt WP, Coffey RM, Lopez-Gonzalez L
AHRQ Author: Andrews RM, Washington RE
Understanding racial and ethnic disparities in postsurgical complications occurring in U.S. hospitals.
This study of 5,474,067 inpatient surgical discharges examined the role of patient, hospital, and community characteristics on racial and ethnic disparities in in-hospital postsurgical complications. It concluded that race does not appear to be an important determinant of in-hospital postsurgical complications, but insurance and community characteristics have an effect.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Witt WP, Coffey RM, Lopez-Gonzalez L .
Understanding racial and ethnic disparities in postsurgical complications occurring in U.S. hospitals.
Health Serv Res 2017 Feb;52(1):220-43. doi: 10.1111/1475-6773.12475.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Disparities, Surgery, Adverse Events
Simon AE, Boss EF, Zelaya CE
Racial and ethnic differences in receipt of pressure equalization tubes among US children, 2014.
More than 20 years ago, differences according to race/ethnicity in the national prevalence of having had pressure equalization tubes (PETs) placed were documented. This study found that, as of 2014, nearly 9 percent of US children have had PETs placed. Non-Hispanic white children still have a greater prevalence of PET placement compared with non-Hispanic black and Hispanic children.
AHRQ-funded; HS022932.
Citation: Simon AE, Boss EF, Zelaya CE .
Racial and ethnic differences in receipt of pressure equalization tubes among US children, 2014.
Acad Pediatr 2017 Jan - Feb;17(1):88-94. doi: 10.1016/j.acap.2016.07.004.
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Keywords: Children/Adolescents, Disparities, Ear Infections, Racial and Ethnic Minorities, Surgery
Goodman SM, Mandl LA, Parks ML
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Race is an important predictor of total knee arthroplasty (TKA) outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA. This study found that blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandl LA, Parks ML .
Disparities in TKA outcomes: census tract data show interactions between race and poverty.
Clin Orthop Relat Res 2016 Sep;474(9):1986-95. doi: 10.1007/s11999-016-4919-8.
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Keywords: Disparities, Racial and Ethnic Minorities, Social Determinants of Health, Patient-Centered Outcomes Research, Surgery
Dimick J, Ruhter J, Sarrazin MV
Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions.
The authors assessed the extent to which living in racially segregated areas and living in geographic proximity to low-quality hospitals contribute to the disparity of black patients undergoing surgery at lower-quality hospitals more frequently than whites. Using Medicare data, they found that black patients tended to live closer to higher-quality hospitals than white patients but were more likely to receive surgery at low-quality hospitals. To address these disparities, care navigators and public reporting of comparative quality could steer patients and their referring physicians to higher-quality hospitals, while quality improvement efforts could focus on improving outcomes for high-risk surgery at hospitals that disproportionately serve black patients.
AHRQ-funded; HS017765.
Citation: Dimick J, Ruhter J, Sarrazin MV .
Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions.
Health Aff 2013 Jun;32(6):1046-53. doi: 10.1377/hlthaff.2011.1365.
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Keywords: Disparities, Quality of Care, Hospitals, Racial and Ethnic Minorities, Surgery