05 Aug TRICARE Study Finds No Racial Disparities in Heart Surgery Care
MedicalResearch.com Interview with:
Muhammad Ali Chaudhary, MD
Center for Surgery and Public Health
Department of Surgery
Brigham and Women’s Hospital
Harvard Medical School
Harvard T. H. Chan School of Public Health
MedicalResearch.com: What is the background for this study?
Response: Many studies have documented disparities in cardiovascular care for minorities, specifically African Americans compared to white patients. Coronary artery bypass grafting (CABG) is a common procedure in the United States, and the outcomes and post-surgical care for African Americans tend to be worse. We examined whether patients insured through TRICARE — a universal insurance and equal-access integrated healthcare system that covers more than 9 million active-duty members, veterans and their families — experienced these disparities. We found no racial disparities in quality-of-care outcomes, providing insights about the potential impacts of universal insurance and an equal-access health care system.
The study included 8,183 TRICARE patients, aged 18-64, who had undergone CABG. The study took its data from TRICARE health care claims from the Military Health System Data Repository for the years of 2006 to 2014.
MedicalResearch.com: What are the main findings?
Response: The primary outcomes for the study were prescription of beta blockers, prescription of statins, and readmission rates within a 30-day period following surgery.
All three outcomes are quality-of-care metrics endorsed by the National Quality Forum (NQF) for CABG. African Americans were found to have 10 percent greater odds of beta-blocker prescription than whites and 10 percent lower odds of 30-day readmission, but neither of these findings reached statistical significance. The team found no difference in statin prescription by race.
Overall, the study showed no significant difference in quality-of-care metrics for African American and white patients following CABG
MedicalResearch.com: What should readers take away from your report?
Response: This study provides a window into the impact of a universal insurance and equal access system on racial disparities in surgical care. The study findings show that an integrated universal healthcare system has the ability to mitigate and potentially eliminate racial disparities in healthcare.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Prior studies on insurance expansion has demonstrated limited impact on racial disparities, supporting the contention that universal insurance alone might not completely do away with racial disparities. We hypothesize that the difference in our findings, in TRICARE beneficiaries, compared to prior studies on insurance expansion may be linked to societal factors such as implicit provider bias and healthcare segregation. In the military, as the saying goes, “the color of your uniform is more important than the color of your skin”, many of these societal factors are reduced or completely absent. Our results call for a deeper exploration of factors, other than insurance, that potentiate racial disparities and policy efforts that aim to ensure equal access, taking these factors into account.
MedicalResearch.com: Is there anything else you would like to add?
Response: This study was performed in collaboration with the Uniformed Services University of Health Science and the was funded by the Henry M. Jackson Foundation for the Advancement of Military Medicine.
No Racial Disparities In Surgical Care Quality Observed After Coronary Artery Bypass Grafting In TRICARE Patients” Health Affairs DOI: 10.1377/hlthaff.2019.00265
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