Daifeng He, a Schroeder Center faculty affiliate, Jennifer Mellor, Director of the Schroeder Center for Health Policy, and Eytan Jankowitz, a William & Mary graduate (Class of ’11), have a new study on cardiac care disparities, entitled, “Racial and Ethnic Disparities in the Surgical Treatment of Acute Myocardial Infarction: The Role of Hospital and Physician Effects,” forthcoming in a 2013 issue of Medical Care Research and Review.
Many studies document racial and ethnic disparities in the treatment of acute myocardial infarction (AMI). He, Mellor, and Jankowitz investigate racial and ethnic treatment disparities by examining the role that hospital and physician characteristics might play in the propensity to treat cardiac patients with one of three AMI treatments – cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG). Differences in hospitals where minority and non-minority patients obtain treatment and the differences in physicians who treat minority and non-minority patients could potentially be significant drivers behind racial and ethnic disparities in cardiac care. For example, past research has shown that minorities are more likely to be treated at lower quality hospitals and that black patients admitted to a hospital for AMI are less likely to be treated by an attending cardiologist.
To examine the role of hospital and physician effects on the treatment of acute myocardial infarction, He, Mellor, and Jankowitz use Florida hospital inpatient discharge data on Medicare fee-for-service patients age 65 and over to estimate models of the three AMI treatments. They find that controlling for hospital effects does not explain racial (black-white) disparities in cardiac care, but largely explains ethnic (Hispanic-white) disparities in cardiac care in Florida. They also show that physician effects partially explain racial disparities in cardiac care and largely explain ethnic disparities in cardiac care in Florida.
These results suggest that improving hospital quality in Hispanic neighborhoods may be a potential path to improve ethnic disparities in cardiac care. Moreover, differences in medical training or other variables that differentiate physicians who treat minority patients should also be considered by policymakers when trying to address racial disparities in cardiac care.
This project is another great example of the kind of faculty-student research collaboration that makes William & Mary unique. Jankowitz performed some of the research for this paper while he was an undergraduate Economics major at William & Mary. He graduated in 2011. "Eytan made important contributions to the dataset construction process and to our research on how to construct controls for certain medical conditions," Mellor says. "These skills, especially the quantitative skills, really helped him on the job market." Jankowitz is currently a consultant at Edgeworth Economics in Washington, D.C.
For information on obtaining access to this study, please visit Medical Care Research and Review.