June 4th, 2013
Racial disparities in health and healthcare are a persistent and troubling problem for the U.S. Despite substantial policy efforts to the contrary, racial and ethnic minorities, especially African-Americans, often receive a lower quality of care and have worse outcomes. The key questions, of course, are why do these disparities exist, and what might we do about them?
Over the past decade, two primary theories have emerged to explain disparities and propose solutions to address them. The first focuses on issues around cultural competence, and suggests that many of the gaps in care are due to poor communication between providers and patients. Given the long history of discrimination against black Americans, the cultural competency theory argues that low trust on the part of patients, combined with the ineffective communication and lack of cultural sensitivity, leads to black patients receiving worse care with resultant poor outcomes. Ultimately, the cultural competency theory begs an approach to health disparities that requires more effective training of providers that care for minority patients.
The second theory of racial disparities in care suggests that the site of care really matters — that disparities are driven by the fact that black patients are more likely to receive care at poor quality hospitals. There is ample evidence for this theory as well – our prior work showed that care for black patients is highly concentrated among a small number of hospitals and these places generally provide a lower quality of care for all their patients. This theory calls for a somewhat different set of solutions: focusing on helping the subset of “minority-serving” providers to improve.
The Dimick Study
Of course, there need not be any contradiction between these two theories and one may suspect that both are likely at play. It is in this context that we have a terrific new study by Justin Dimick and colleagues from the University of Michigan, in the newly released June issue of Health Affairs, that helps us better understand why black patients generally have higher mortality after major surgeries than their white counterparts, and how we might try to reduce this gap.Read the rest of this entry »