Disparities in surgical care, including access to and quality of care, are pervasive and long standing in our healthcare system. Black patients are much less likely to receive life-saving or life-enhancing surgical procedures, and when they do, they are more likely to experience poor clinical outcomes, including higher readmission rates and mortality, compared with white patients. We know, for instance, that there are racial disparities in surgical readmissions but we don't understand the reasons that underlie these differences. Reducing surgical readmissions has become a national priority because it likely reflects complex and critical aspects of care that requires communication and coordination between providers and patients, appropriate recovery from complications, and generally safer, better care. There have been a series of national programs, culminating in specific initiatives under the Affordable Care Act, which have focused on reducing readmissions. As these national programs have taken hold, we have little information about whether there have been reductions in surgical disparities. Just as importantly, we know little about the specific initiatives that organizations have undertaken to reduce disparities and achieve greater health equity. Therefore, we propose to use ten years of longitudinal national Medicare data to examine trends in 30-day surgical readmissions rates in black and white patients, determine whether differences have narrowed over time, identify market-level and hospital-level factors that are associated with the greatest improvement in disparities, and finally, using a national survey of hospital leaders, determine promising strategies to improve outcomes of minority populations. As the nation continues to shift towards value-based care, assessing what progress has been made in reducing disparities in surgical care, where gaps still persist, and what kinds of readmissions strategies appear most promising are all critical to informing future policy and clinical efforts to reduce gaps and ensure greater equity in surgical care.
Disparities in surgical care, including access to and quality of care, are pervasive and longstanding in our healthcare system. In recent years a range of national policies and programs have been implemented to improve the quality of surgical care delivered in the U.S. We need to examine the impact of these efforts on surgical disparities to better understand whether they have closed the gaps. As importantly, we need to identify effective strategies that individual organizations have undertaken that reduce disparities in surgical care.
