Factors Associated With State-Specific Medicaid Expansion and Receipt of Autologous Breast Reconstruction Among Patients Undergoing Mastectomy

Huynh, Kristine A.; Jayaram, Mayank; Wang, Chang; Lane, Megan; Wang, Lu; Momoh, Adeyiza O.; Chung, Kevin C.

doi:10.1001/jamanetworkopen.2021.19141

Cited by 12 publications

(18 citation statements)

References 53 publications

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“…Although previous studies have identified geographic practice variability in breast reconstruction in relation to plastic surgeon density and insurance coverage, 16 , 17 our study is one of the first to investigate guideline awareness on a regional level. Awareness of autologous breast reconstruction guidelines was regionally variable, with respondents from the Mountain West, Northeast, and Southwest regions reporting higher relative rates than their geographic counterparts.…”

Section: Discussionmentioning

confidence: 95%

Guideline Awareness Disparities in Plastic Surgery: A Survey of American Society of Plastic Surgeons

Rames

Lane

Phillips

2022

Plastic and Reconstructive Surgery - Global Open

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Background:The American Society of Plastic Surgeons (ASPS) clinical practice guidelines were constructed to help direct evidence-based surgical management in plastic surgery. Societal member awareness of the recommendations for breast reconstruction has yet to be studied among ASPS members. Methods: Univariate and multivariate analyses were performed using electronic survey data from 243 ASPS members. Characteristics, including respondent demographics, practice distribution, and geographic locations, were correlated to the awareness of autologous and expander/implant-based reconstruction guidelines. Results: Of the respondents, 52% and 35.7% reported awareness for autologous breast reconstruction and expander/implant-based reconstruction guidelines, respectively. Surgeons who performed more general and autologous breast reconstruction were more likely to be aware of autologous breast reconstruction and expander/implant-based guidelines (P = 0.0034 and 0.032). Autologous breast reconstruction guideline awareness was geographically disparate (P = 0.031), with greater awareness in the Northeast (OR, 4.5; 95% CI, 1.63-12.53; P = 0.01) and Southwest (OR, 3.91; 95% CI, 1.18-13.83; P = 0.01). Respondents with larger practice percentages of breast reconstruction and those with higher annual academic meeting attendance reported greater awareness of expander/implant-based guidelines (P = 0.044 and 0.040). Meeting attendance (OR, 2.14; 95% CI, 1.15-8.91; P = 0.022) and practice-based (OR, 3.14; 95% CI, 1.52-8.91; P = 0.027) awareness disparities were also appreciated on multivariate analysis. Conclusions: Guideline awareness in plastic surgery varies by practice composition and geography. These findings can be used to help inform more targeted educational and implementation strategies in breast reconstruction.

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Section: Discussionmentioning

confidence: 95%

Guideline Awareness Disparities in Plastic Surgery: A Survey of American Society of Plastic Surgeons

Rames

Lane

Phillips

2022

Plastic and Reconstructive Surgery - Global Open

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“…This study has limitations. Our findings are dependent on the accuracy of the data coded in the database; however, HCUP is one of the largest longitudinal hospital databases in the United States and is commonly used in the surgical literature to study health care outcomes . Additionally, the implicit bias data used in this study do not provide any information on potential confounding variables, ie, education, which may impact measures of implicit bias.…”

Section: Discussionmentioning

confidence: 97%

Regional Implicit Racial Bias and Rates of Breast Reconstruction, Complications, and Cost Among US Patients With Breast Cancer

et al. 2023

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ImportanceRacial disparities influencing breast reconstruction have been well-researched; however, the role of implicit racial bias remains unknown. An analysis of the disparities in care for patients with breast cancer may serve as a policy target to increase the access and quality of care for underserved populations.ObjectiveTo identify whether variations in implicit racial bias by region are associated with the differences in rates of immediate breast reconstruction, complications, and cost for White patients and patients from minoritized racial and ethnic groups.Design, Setting, and ParticipantsThis cohort study used data from the National Inpatient Sample (NIS) from 2009 to 2019. Adult female patients with a diagnosis of or genetic predisposition for breast cancer receiving immediate breast reconstruction at the time of mastectomy were included. Patients receiving both autologous free flap and implant-based reconstruction were included in this analysis. US Census Bureau data were extracted to compare rates of reconstruction proportionately. The Implicit Association Test (IAT) was used to classify whether implicit bias was associated with the primary outcome variables. Data were analyzed from April to November 2022.ExposureIAT score by US Census Bureau geographic region.Main Outcomes and MeasuresVariables of interest included demographic data, rate of reconstruction, complications (reconstruction-specific and systemic), inpatient cost, and IAT score by region. Spearman correlation was used to determine associations between implicit racial bias and the reconstruction utilization rate for White patients and patients from minoritized racial and ethnic groups. Two-sample t tests were used to analyze differences in utilization, complications, and cost between the 2 groups.ResultsA total of 52 115 patients were included in our sample: 38 487 were identified as White (mean [SD] age, 52.0 [0.7] years) and 13 628 were identified as minoritized race and ethnicity (American Indian, Asian, Black, and Hispanic patients and patients with another race or ethnicity; mean [SD] age, 49.7 [10.5] years). Implicit bias was not associated with disparities in breast reconstruction rates, complications, or cost. Nonetheless, the White-to–minoritized race and ethnicity utilization ratio differed among the regions studied. Specifically, the reconstruction ratio for White patients to patients with minoritized race and ethnicity was highest for the East South Central Division, which includes Alabama, Kentucky, Mississippi, and Tennessee (2.17), and lowest for the West South Central Division, which includes Arkansas, Louisiana, Oklahoma, and Texas (0.75).Conclusions and RelevanceIn this cohort study of patients with breast cancer, regional variation of implicit bias was not associated with differences in breast reconstruction utilization, complications, or cost. Regional disparities in utilization among racial and ethnic groups suggest that collaboration from individual institutions and national organizations is needed to develop robust data collection systems. Such systems could provide surgeons with a comparative view of their care. Additionally, collaboration with high-volume breast centers may help patients in low-resource settings receive the desired reconstruction for their breast cancer care, helping improve the utilization rate and quality of care.

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“…These members in turn are key in fostering connectedness and trust, which may be lacking due to historical and contemporary acts of medical misconduct and discrimination 76,77,90–92 . Community outreach involves information sharing, which is a 2-way process, examples of which have been reported across a variety of specialties 90–94 . The University of Cincinnati Cochlear Implant Program surveyed African Americans with cochlear implants to identify socioeconomic and cultural barriers to seeking assistance for their hearing loss, specifically cochlear implant surgery.…”

Section: Interventions That Reduce Racial and Ethnic Inequities In Su...mentioning

confidence: 99%

Surgical Care for Racial and Ethnic Minorities and Interventions to Address Inequities

et al. 2023

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Objective: Racial and ethnic inequities in surgical care in the United States are well documented. Less is understood about evidence-based interventions that improve surgical care and reduce or eliminate inequities. In this review, we discuss effective patient, surgeon, community, health care system, policy, and multi-level interventions to reduce inequities and identifying gaps in intervention-based research. Background: Evidenced-based interventions to reduce racial and ethnic inequities in surgical care are key to achieving surgical equity. Surgeons, surgical trainees, researchers, and policy makers should be aware of the evidence-based interventions known to reduce racial and ethnic disparities in surgical care for prioritization of resource allocation and implementation. Future research is needed to assess interventions effectiveness in the reduction of disparities and patient-reported measures. Methods: We searched PubMed database for English-language studies published from January 2012 through June 2022 to assess interventions to reduce or eliminate racial and ethnic disparities in surgical care. A narrative review of existing literature was performed identifying interventions that have been associated with reduction in racial and ethnic disparities in surgical care. Results and Conclusions: Achieving surgical equity will require implementing evidenced-based interventions to improve quality for racial and ethnic minorities. Moving beyond description toward elimination of racial and ethnic inequities in surgical care will require prioritizing funding of intervention-based research, utilization of implementation science and community based-participatory research methodology, and principles of learning health systems.

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Factors Associated With State-Specific Medicaid Expansion and Receipt of Autologous Breast Reconstruction Among Patients Undergoing Mastectomy

Cited by 12 publications

References 53 publications

Guideline Awareness Disparities in Plastic Surgery: A Survey of American Society of Plastic Surgeons

Guideline Awareness Disparities in Plastic Surgery: A Survey of American Society of Plastic Surgeons

Regional Implicit Racial Bias and Rates of Breast Reconstruction, Complications, and Cost Among US Patients With Breast Cancer

Surgical Care for Racial and Ethnic Minorities and Interventions to Address Inequities

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