Provider Care Team Segregation and Operative Mortality Following Coronary Artery Bypass Grafting

Abstract

Background: Studies have shown that Black patients die more frequently following coronary artery bypass grafting than their White counterparts for reasons not fully explained by disease severity or comorbidity. To examine whether provider care team segregation within hospitals contributes to this inequity, we analyzed national Medicare data. Methods: Using national Medicare data, we identified beneficiaries who underwent coronary artery bypass grafting at hospitals where this procedure was performed on at least 10 Black and 10 White patients between 2008 and 2014 (n=12 646). After determining the providers who participated in their perioperative care, we examined the extent to which Black and White patients were cared for by unique networks of provider care teams within the same hospital. We then evaluated whether a lack of overlap in composition of the provider care teams treating Black versus White patients (ie, high segregation) was associated with higher 90-day operative mortality among Black patients. Results: The median level of provider care team segregation was high (0.89) but varied across hospitals (interquartile range, 0.85–0.90). On multivariable analysis, after controlling for patient-, hospital-, and community-level differences, mortality rates for White patients were comparable at hospitals with high and low levels of provider care segregation (5.4% [95% CI, 4.7%–6.1%] versus 5.8% [95% CI, 4.7%–7.0%], respectively; P =0.601), while Black patients treated at high-segregation hospitals had significantly higher mortality than those treated at low-segregation hospitals (8.3% [95% CI, 5.4%–12.4%] versus 3.3% [95% CI, 2.0%–5.4%], respectively; P =0.017). The difference in mortality rates for Black and White patients treated at low-segregation hospitals was nonsignificant (−2.5%; P =0.098). Conclusions: Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.