Kristen R. Mathias MD , Ofure Akhiwu MD , Ali M. Mustafa MD , Kevin J. Psoter PhD , Edward S. Chen MD , Nisha A. Gilotra MD , Nancy W. Lin MD , John Odackal MD , Catherine A. Bonham MD , Michelle Sharp MD
{"title":"延迟转介到多学科护理黑人个体结节病","authors":"Kristen R. Mathias MD , Ofure Akhiwu MD , Ali M. Mustafa MD , Kevin J. Psoter PhD , Edward S. Chen MD , Nisha A. Gilotra MD , Nancy W. Lin MD , John Odackal MD , Catherine A. Bonham MD , Michelle Sharp MD","doi":"10.1016/j.chpulm.2024.100125","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Sarcoidosis is a complex granulomatous disease that benefits from multidisciplinary subspecialty expertise. Inequitable access to care contributes to racial disparities in many diseases; however, to our knowledge, no studies have examined racial differences in referral times to Sarcoidosis Centers of Excellence.</div></div><div><h3>Research Question</h3><div>Is there an association between race and time from sarcoidosis diagnosis to referral to an independently certified, peer-reviewed World Association of Sarcoidosis and Other Granulomatous Disorders Center of Excellence? Does a referral result in a change in sarcoidosis management?</div></div><div><h3>Study Design and Methods</h3><div>We retrospectively reviewed all 2021 referrals to the Johns Hopkins Sarcoidosis Center of Excellence. Multivariable Cox regression evaluated the association between race and time to referral, adjusting for covariates of sex, ethnicity, referral type, referral provider, insurance provider, employment status, organ involvement, and sarcoidosis medications. Changes in sarcoidosis management including treatment changes, additional organ evaluation, and/or additional subspecialty expertise were ascertained 1 year after establishing care.</div></div><div><h3>Results</h3><div>At total of 207 individuals were analyzed (40% Black, 55% White, and 5% Asian and other race). Black individuals experienced longer referral delay than White individuals, with a median of 9 vs 5 years, respectively (<em>P</em> < .05). In multivariable analysis, the hazard of referral for White individuals was higher than for Black individuals (hazard ratio, 2.04; 95% CI, 1.48-2.82; <em>P</em> < .001), independent of the covariates. Sarcoidosis management changed in 78% of individuals after referral.</div></div><div><h3>Interpretation</h3><div>Black patients experienced significant delays in referral to a multidisciplinary subspecialty Sarcoidosis Center of Excellence compared with other racial groups. Recognition of referral delay may offer insight and opportunity to address disparities in clinical outcomes observed in Black individuals with sarcoidosis. Future multicenter studies must quantify the impact of care received through World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Centers of Excellence, define patient phenotypes in need of urgent referral, and develop targeted patient and provider outreach.</div></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"3 2","pages":"Article 100125"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Delays in Referral to Multidisciplinary Care for Black Individuals With Sarcoidosis\",\"authors\":\"Kristen R. Mathias MD , Ofure Akhiwu MD , Ali M. Mustafa MD , Kevin J. Psoter PhD , Edward S. Chen MD , Nisha A. Gilotra MD , Nancy W. Lin MD , John Odackal MD , Catherine A. Bonham MD , Michelle Sharp MD\",\"doi\":\"10.1016/j.chpulm.2024.100125\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Sarcoidosis is a complex granulomatous disease that benefits from multidisciplinary subspecialty expertise. Inequitable access to care contributes to racial disparities in many diseases; however, to our knowledge, no studies have examined racial differences in referral times to Sarcoidosis Centers of Excellence.</div></div><div><h3>Research Question</h3><div>Is there an association between race and time from sarcoidosis diagnosis to referral to an independently certified, peer-reviewed World Association of Sarcoidosis and Other Granulomatous Disorders Center of Excellence? Does a referral result in a change in sarcoidosis management?</div></div><div><h3>Study Design and Methods</h3><div>We retrospectively reviewed all 2021 referrals to the Johns Hopkins Sarcoidosis Center of Excellence. Multivariable Cox regression evaluated the association between race and time to referral, adjusting for covariates of sex, ethnicity, referral type, referral provider, insurance provider, employment status, organ involvement, and sarcoidosis medications. Changes in sarcoidosis management including treatment changes, additional organ evaluation, and/or additional subspecialty expertise were ascertained 1 year after establishing care.</div></div><div><h3>Results</h3><div>At total of 207 individuals were analyzed (40% Black, 55% White, and 5% Asian and other race). Black individuals experienced longer referral delay than White individuals, with a median of 9 vs 5 years, respectively (<em>P</em> < .05). In multivariable analysis, the hazard of referral for White individuals was higher than for Black individuals (hazard ratio, 2.04; 95% CI, 1.48-2.82; <em>P</em> < .001), independent of the covariates. Sarcoidosis management changed in 78% of individuals after referral.</div></div><div><h3>Interpretation</h3><div>Black patients experienced significant delays in referral to a multidisciplinary subspecialty Sarcoidosis Center of Excellence compared with other racial groups. Recognition of referral delay may offer insight and opportunity to address disparities in clinical outcomes observed in Black individuals with sarcoidosis. Future multicenter studies must quantify the impact of care received through World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Centers of Excellence, define patient phenotypes in need of urgent referral, and develop targeted patient and provider outreach.</div></div>\",\"PeriodicalId\":94286,\"journal\":{\"name\":\"CHEST pulmonary\",\"volume\":\"3 2\",\"pages\":\"Article 100125\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-12-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CHEST pulmonary\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2949789224000916\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CHEST pulmonary","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2949789224000916","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Delays in Referral to Multidisciplinary Care for Black Individuals With Sarcoidosis
Background
Sarcoidosis is a complex granulomatous disease that benefits from multidisciplinary subspecialty expertise. Inequitable access to care contributes to racial disparities in many diseases; however, to our knowledge, no studies have examined racial differences in referral times to Sarcoidosis Centers of Excellence.
Research Question
Is there an association between race and time from sarcoidosis diagnosis to referral to an independently certified, peer-reviewed World Association of Sarcoidosis and Other Granulomatous Disorders Center of Excellence? Does a referral result in a change in sarcoidosis management?
Study Design and Methods
We retrospectively reviewed all 2021 referrals to the Johns Hopkins Sarcoidosis Center of Excellence. Multivariable Cox regression evaluated the association between race and time to referral, adjusting for covariates of sex, ethnicity, referral type, referral provider, insurance provider, employment status, organ involvement, and sarcoidosis medications. Changes in sarcoidosis management including treatment changes, additional organ evaluation, and/or additional subspecialty expertise were ascertained 1 year after establishing care.
Results
At total of 207 individuals were analyzed (40% Black, 55% White, and 5% Asian and other race). Black individuals experienced longer referral delay than White individuals, with a median of 9 vs 5 years, respectively (P < .05). In multivariable analysis, the hazard of referral for White individuals was higher than for Black individuals (hazard ratio, 2.04; 95% CI, 1.48-2.82; P < .001), independent of the covariates. Sarcoidosis management changed in 78% of individuals after referral.
Interpretation
Black patients experienced significant delays in referral to a multidisciplinary subspecialty Sarcoidosis Center of Excellence compared with other racial groups. Recognition of referral delay may offer insight and opportunity to address disparities in clinical outcomes observed in Black individuals with sarcoidosis. Future multicenter studies must quantify the impact of care received through World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Centers of Excellence, define patient phenotypes in need of urgent referral, and develop targeted patient and provider outreach.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
