Relationship Between Health Care Team Segregation and Receipt of Care by a Cardiologist According to Patient Race in a Midwestern State.

Abstract

Background: Segregation index (SI) has been associated with worsened health. However, the relationship between SI within health care teams (degree of heterogeneity between teams caring for Black compared with White patients) and cardiovascular care is unclear among adequately insured populations. We sought to assess the relationship between health care team SI, patient race, receipt of care by a cardiologist, 1-year survival, and 30-day readmission rates for Black compared with White patients admitted with heart failure, ischemic heart disease, or valvular heart disease.

Methods: Using Optum's de-identified Clinformatics Data Mart Database (CDM) from 2009 to 2020, generalized linear mixed-effects were used to analyze effects of patient race and SI on receipt of care by a cardiologist, and care by a cardiologist on 1-year survival and 30-day readmission.

Results: Among 6572 patients (17.1% Black), the odds of receiving care by a cardiologist were 31.3% less for Black than White patients (adjusted odds ratio 0.687 [95% CI, 0.545-0.872]; P=0.001). However, there was no statistically significant association of SI on receipt of care by a cardiologist (P=0.14). For those seen by a cardiologist, the adjusted odds ratio (Black-to-White) of 1-year survival increased with increasing SI (P=0.02). SI had no statistically significant effect on 30-day readmission (P=0.86).

Conclusions: Among patients hospitalized for heart failure, ischemic heart disease, or valvular heart disease, segregation of health care teams was not associated with receipt of care by cardiologists in Indiana hospitals. When cardiologists were included, the odds of 1-year survival increased for Black versus White patients with increasing segregation of clinicians, and segregation was not associated with 30-day readmission.