Evidence indicates that racial and ethnic minority patients undergoing surgery receive worse quality care and experience worse outcomes than White patients do in the U.S. ?Clinician factors? are one of five key determinants of surgical disparities identified at the National Institutes of Health and American College of Surgeons Summit in 2015. However, little is known about the characteristics of surgeons who deliver high- quality care to racial and ethnic minority patients, and whether education and training surgeons received affect surgical disparities. These knowledge gaps have hindered efforts to develop interventions that can effectively close the disparity gap in surgical care. The proposed R01 project will create a comprehensive, multi-level database that includes detailed information about patients, surgeons, medical schools surgeons attended, and residency programs surgeons completed, by linking four large, nationally-representative datasets: (1) Medicare data, (2) comprehensive physician database assembled by Doximity, (3) the AAMC Medical School database, and (4) the AMA Residency database.
In Aim 1, using this innovative dataset, we will examine whether surgical care (i.e., processes of care, patient outcomes, and utilizations) differ between Black or Hispanic patients versus White patients when they are treated by the same surgeons using multi-level regression models.
In Aim 2, we will identify individual characteristics of surgeons (e.g., age, gender, whether surgeons speak languages other than English, and the proportion of patients treating who are racial/ethnic minorities [?minority-serving surgeons?]) that are associated with racial/ethnic disparities in surgical care. Finally, using the information on the characteristics of medical schools and residency programs collected by AAMC and AMA, Aim 3 will determine whether the characteristics of medical schools (e.g., the proportion of racial/ethnic minority faculty/students, the percentage of international students, location in rural vs. urban areas) and residency programs (e.g., the proportion of racial and ethnic minority faculty/students/patients, the presence of cultural competence awareness program, instruction in non-English languages) related to cultural competency lead to improved surgical care received by racial and ethnic minority patients. The proposed R01 project will provide a unique opportunity to advance the field by better understanding the mechanisms of disparities related to surgeon factors, and will identify potentially modifiable attributes of surgeons, medical schools, and residency programs that contribute to disparities in surgical care. This project will provide a strong evidence base for developing interventions, such as evidence-based cultural competency programs and Continuing Medical Education, which can effectively reduce racial and ethnic disparities in surgical care. The research team consists of multiple NIH-funded researchers with expertise in all relevant fields (health services research, disparity research, surgical education, and statistics) to conduct this innovative research. The proposed study aligns well with the NIH strategic plan for research in minority health and health disparities.

Public Health Relevance

Racial and ethnic disparities in surgical care and outcomes have been a persistent and well-documented public health problem in the U.S.; however, strategies to effectively close this disparity gap have not been developed. Using an innovative dataset that includes comprehensive information on (1) patient characteristics, (2) surgeon factors, and (3) characteristics of medical schools and residency programs (e.g., the proportion of racial and ethnic minority faculty/peers/patients, the presence of cultural competency programs), the investigators will determine the impact of individual surgeon factors and education/training on racial and ethnic disparities in surgical care and outcomes. This research has the potential to offer novel approaches for unraveling one of the key determinants of disparities in surgery??surgeon factors??and to provide a strong evidence base for developing interventions that can effectively reduce racial and ethnic disparities in surgical care.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Dagher, Rada Kamil
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University of California Los Angeles
Internal Medicine/Medicine
Schools of Medicine
Los Angeles
United States
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