Racial disparities in surgical outcomes: Does the level of resident surgeon play a role?

Changoor, Navin R.; Ortega, Gezzer; Ekladios, Mina; Zogg, Cheryl K.; Cornwell, Edward E.; Haider, Adil H.

doi:10.1016/j.surg.2015.03.046

Cited by 7 publications

(3 citation statements)

References 24 publications

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“…First, variability in clinical skills and the inherently limited experience of residents, particularly in the ambulatory setting, may lead to lower quality of care, including achieving chronic disease management targets and preventive cancer screening tests, among resident patients. [45][46][47][48][49] Second, the disruption in continuity caused by patient transition of care every 2 to 3 years to another resident provider may impact the management of chronic diseases and preventive care, resulting in delays in testing and adverse patient outcomes. [50][51][52][53] Third, as reflected in this cohort, resident PCPs tend to have patient panels with a higher proportion of medically and socially complex individuals compared to staff PCPs which may result in disparate patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?

Essien

Ray

et al. 2019

J GEN INTERN MED

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BACKGROUND: Outpatient primary care experience is vital to internal medicine resident training but may impact quality and equity of care delivered in practices that include resident physicians. Understanding whether quality differences exist among resident and staff primary care physicians (PCPs) may present an opportunity to address health disparities within academic medical centers. OBJECTIVE: To determine whether there are differences in the quality of primary care provided by resident PCPs compared to staff PCPs. DESIGN: A retrospective cohort study with a propensitymatched analysis. PARTICIPANTS: 143,274 patients, including 10,870 patients managed by resident PCPs, seen in 16 primary care practices affiliated with an academic medical center. MAIN MEASURES: Guideline-concordant chronic disease management of diabetes (HbA1c, LDL) and coronary artery disease (LDL), preventive breast, cervical, and colorectal cancer screening, and resource utilization measures including emergency department (ED) visits, hospitalizations, high-cost imaging, and patient-reported health experience. KEY RESULTS: At baseline, there were significant differences in sociodemographic and clinical characteristics between resident and staff physician patients. Resident patients were less likely to achieve chronic disease and preventive cancer screening outcome measures including LDL at goal (adjusted OR [aOR] 0.77 [95% CI 0.65, 0.92]) for patients with coronary artery disease; HbA1c at goal (aOR 0.73 [95% CI 0.62, 0.85]) for patients with diabetes; breast (aOR 0.56 [95% CI 0.49, 0.63]), cervical (aOR 0.66 [95% CI 0.60, 0.74]), and colorectal (aOR 0.72 [95% CI 0.65, 0.79] cancer screening. Additionally, resident patients had higher rates of ED visits and hospitalizations but lower rates of high-cost imaging. Resident patients reported lower rates of satisfaction with certain access to care and communication measures. Similar outcomes were noted in propensity-matched sensitivity analyses.CONCLUSION: After controlling for differences in sociodemographic and clinical factors, resident patients were less likely to achieve chronic disease and preventive cancer screening outcomes compared to staff patients. Further efforts to address ambulatory trainee education and primary care quality along with novel approaches to the management of the disproportionately disadvantaged resident patient panels are needed.

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Section: Discussionmentioning

confidence: 99%

Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?

Essien

Ray

et al. 2019

J GEN INTERN MED

View full text Add to dashboard Cite

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“…Today, black, Hispanic, and Asian patients are more likely to be operated on by senior residents than by attending surgeons operating alone. We do not know, however, whether these disparities reflect primarily between-or within-hospital differences (26). Nonetheless, compared with attending surgeons operating alone, senior residents have higher rates of major and minor complications (26).…”

Section: Principle 6 Differences Between and Within Geographic Areasmentioning

confidence: 98%

“…We do not know, however, whether these disparities reflect primarily between-or within-hospital differences (26). Nonetheless, compared with attending surgeons operating alone, senior residents have higher rates of major and minor complications (26). Similarly, minority medical patients continue to be cared for more often by trainees rather than by staff physicians within hospital systems (157).…”

Section: Principle 6 Differences Between and Within Geographic Areasmentioning

confidence: 99%

Racial and Ethnic Disparities in the Quality of Health Care

Fiscella

Sanders

2016

Annu. Rev. Public Health

365

232

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The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

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Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity

et al. 2017

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Following propensity-matched analysis of cancer patients undergoing laparoscopic colectomy, chief residents, and fellows were associated with worsened operative outcomes compared to attending along cases, while junior and mid-level resident outcomes were no different. Further study is necessary to determine what effect the PGY surgical trainee level has on post-operative morbidity in cancer patients undergoing laparoscopic colectomy in the context of multiple collinear factors.

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Racial disparities in surgical outcomes: Does the level of resident surgeon play a role?

Cited by 7 publications

References 24 publications

Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?

Disparities in Quality of Primary Care by Resident and Staff Physicians: Is There a Conflict Between Training and Equity?

Racial and Ethnic Disparities in the Quality of Health Care

Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity

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