Drivers of Racial and Ethnic Disparities in Cardiac Rehabilitation Use Patient and Provider Perspectives

Article

Drivers of Racial and Ethnic Disparities in Cardiac Rehabilitation Use Patient and Provider Perspectives

June 27, 2015

Abstract

Cardiac rehabilitation (CR) use is lower for racial and ethnic minorities than White
patients. The purpose of this study was to identify factors that drive this disparity at
the system, provider, and patient levels. A mixed methods study combined descriptive
analysis of 2007 Medicare claims data and thematic analysis of 19 clinician interviews,
8 minority patient focus groups and 8 one-on-one interviews with minority heart
patients across three communities. The disparity between White and non-White
CR use ranged from 7 to 11 percentage points among study sites (p < .05). Key
themes suggest disparities are driven by (a) flawed financing and reimbursement
that creates disincentives to invest in CR programs, (b) a health care system whose
priorities are misaligned with the needs of patients, and (c) subjective decision-making
around referral processes. These findings suggest that the health care system needs
to address multiple levels of problems to mitigate disparities in CR use.

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