CDSP Recipients Spring 2016

Recipient: Steven Skube, MD (Surgery Resident, UMN)

Title: “Are African American men more likely to receive an ostomy after treatment for penetrating abdominal trauma

than other races?”

Mentor(s): Mary Kwaan, MD and Michael Mcgonigal, MD

Abstract/background: My proposed cohort is trauma patients in the National Trauma Data Bank (NTDB), years 2010-2014. This would be further categorized by male patience over the age of 14. The mechanism of injury will be penetrating abdominal trauma. International Classification of Diseases, 9th Edition (ICD9) codes will be used to define the appropriate patients, based on prior literature.

Previous publications using the NTDB have demonstrated a 10 fold higher rate of penetrating trauma in uninsured black patients in comparison to insured white patients. The leading cause of death in ages 1-34 is some form of trauma in African American men. Publications have also demonstrated race and insurance status as a predictor of mortality after trauma and access to rehabilitation after traumatic brain injury. Creation of a stoma in associated with post-operative complications and a lower quality of life. Trauma literature demonstrates that a stoma is not recommended in most colon injuries due to penetrating trauma. I propose to study differences in operative intervention for penetrating abdominal trauma, particularly ostomy creation. Given the disproportionate prevalence of penetrating trauma in the African American population, I believe studying this difference in surgical care can further delineate reasons for unequal cares and outcomes between the races.

 

Recipient:  Jessica Williams, MPH, PhD (Assistant Professor, UAB)

Title: “Does hospital system affiliation mediate the relationship between race and 30-day hospital readmissions after an acute myocardial infarction (AMI)?”

Mentor(s): Allyson Hall, PhD Health Services Administration, UAB

Abstract:  This analysis will compare African American men who have had an acute myocardial infarction with white men and men of other races who have had an acute myocardial infarction.  The comparison will focus on men who are readmitted within 30 days of discharge for non-scheduled treatments or due to complications.

Where patients receive care impacts outcomes of care.  In general, African Americans who are hospitalized are more likely to be readmitted and the hospital in which care is received accounts for some of the disparity in readmissions (Giratti et al, 2013). Prior studies have found that a small number of hospitals provide a disproportionate share of care for minority patients and typically these hospitals have the worst performance on processes of care (Jha et al, 2007; Ayanian et al, 2003).

African Americans who have an AMI tend to fair worse than other races after treatment.  Disparities in mortality after AMI have declined but remain higher for African American men than white men (Singh et al, 2014).  In patients younger than age 75, life expectancy is lower in blacks than whites after an AMI across all income levels (Bucholz et al, 2015).  African American AMI patients who receive care in high minority-serving hospitals tend to have higher readmission rates (Joynt et al, 2011).

Most prior studies have examined the relationship between hospital characteristics and disparities using Medicare claims data and explore hospital characteristics such as size, teaching status, financial stress and public ownership.  This study aims to explore the role of hospital system affiliation and its impact on 30-day readmissions after an AMI for African American men.