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

• Published in: Medical care research and review Vol. 73; no. 3; p. 251
• Main Authors: Mead, Holly, Ramos, Christal, Grantham, Sarah C
• Format: Journal Article
• Language: English
• Published: United States 01.06.2016
• Subjects: Aged; Cardiac Rehabilitation - economics; Cardiac Rehabilitation - statistics & numerical data; Continental Population Groups - statistics & numerical data; Female; Focus Groups; Healthcare Disparities - economics; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Healthcare Financing; Humans; Interviews as Topic; Male; Middle Aged; Referral and Consultation; Reimbursement Mechanisms; United States; disparities; cardiac rehabilitation; health care delivery system
• ISSN: 1552-6801
• DOI: 10.1177/1077558715606261

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.