부산대학교 도서관

Background: High levels of hospital health care team segregation has been associated with worse outcomes for Black patients. We sought to determine whether hospital level segregation index (SI, degree of dissimilarity between composition of teams that care for Black versus White patients) was associated with care by a cardiologist, 30-day readmission, and 1-year survival for Black versus White patients with heart failure (HF).Methods: Using Optum’s de-identified Clinformatics® Data Mart Database, for commercial and Medicare plans, we examined SI among Black and White patients admitted with primary diagnosis of HF from 2010-2018. Hospitals were stratified into three SI groups based on tertiles from least to most segregated hospital teams. Generalized linear mixed-effects models were used to evaluate each outcome including effects of race, SI, race by SI as well as gender, age-adjusted Charlson Comborbidity Index, and hospital factors. For 30-day readmission and 1-year survival, we included effects of cardiology care, 2 and 3-way interactions of race, SI, and cardiology care.Results: Among 119, 272 patients, Black patients were less likely to be seen by a cardiologist compared to White patients across SI tertiles, particularly medium SI hospitals (OR 0.833, 95% CI 0.770-0.902). There was no significant difference in odds of readmission between races across hospital SI levels and whether seen by a cardiologist. For 1-year survival, the odds were significantly higher for Black patients compared to White patients across all SI levels (Figure).Conclusion: Black patients with commercial or Medicare insurance were less likely to be seen by a cardiologist for HF care than White patients across SI levels, particularly medium SI. Hospital SI levels did not demonstrate a consistent relationship between 30-day readmission and 1-year survival.