The Institute of Medicine defines the six pillars of 'quality'in health care as 'safe, effective, patient- centered, timely, efficient, and equitable'.In an effort to improve the delivery of health care nationwide, provider organizations have mounted numerous Quality Improvement initiatives. However, the achievement of equity remains a challenge as numerous reports document the persistence of disparities despite a wave of Quality Improvement programs. In this context, the delivery of surgical care is under the microscope at multiple levels and the measurement of surgical outcomes is becoming routine. While metrics to compare provider performance in other categories of 'quality'exist, there is currently no standardized method of benchmarking equity in surgical care. This is true despite extensive literature documenting disparate outcomes in surgical care in AHRQ priority populations such as racial and ethnic minorities. Our project addresses this critical barrier in tw critical steps: (1) demonstrating the feasibility of benchmarking racial and ethnic disparities in surgical care by developing and publishing an innovative methodology to capture nationwide variation in racial and ethnic disparities for three surgical procedures by hospital provider, and (2) characterizing hospital attributes that correlate with equitable performance. This project confirms the hypothesis that disparities in surgical care are not uniform across all providers. Our preliminary data from the Nationwide Inpatient Sample reveal performance variation by hospital in the Observed likelihood of providing surgical procedures for racial and ethnic minority patients (i.e. Blacks, Hispanics) when compared to a risk-adjusted Expected likelihood of the same for nonminority White patients. This fundamentally challenges the popular paradigm that racial and ethnic disparities in surgery result primarily from patient factors such as socioeconomic status, insurance status, comorbidities, or even the genetics of race itself. In accordance with the AHRQ mission "to enhance the quality of health care services for all Americans", this project introduces a novel measurement tool for policy-makers and providers to benchmark disparities in surgical care and enables the deployment of Quality Improvement tools towards achieving equity.

Public Health Relevance

In accordance with the AHRQ mission to enhance the quality of health care services for all Americans, we propose a methodology to reduce racial and ethnic disparities in surgical care. Despite extensive documentation of disparities in surgery, organizations monitoring quality in surgical care do not currently report disparities to providers. Our project introduces a novel statistical model to benchmark variation in surgical disparities by provider to identify hospitals where the tools of Quality Improvement should be focused to promote equitable care for Priority Populations.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Postdoctoral Individual National Research Service Award (F32)
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HSR Health Care Research Training SS (HCRT)
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Benjamin, Shelley
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Brigham and Women's Hospital
United States
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