The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in Health Professions -- Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.

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The Right Thing to do, The Smart Thing to do Enhancing Diversity in the Health Professions

rates of post-discharge problems after hospitalizations for several major conditions in a national study of hospital care (Kahn et al., 1994).

Racial variations have been shown in numerous studies of cardiac procedure use and survival after a myocardial infarction. Blacks and Hispanics in New York with angiographically confirmed coronary artery disease were found to be between 36% and 40% less likely to receive bypass surgery than Whites when the surgery was judged medically appropriate, and Blacks were 37% less likely to receive the procedure when judged medically necessary, controlling for disease severity, age, gender, and insurance status (Hannan, 1999). Other studies have found similar results with respect to cardiac care and invasive cardiac procedures, even when controlling for demographic, socioeconomic, and clinical variables (Carlisle et al., 1995; Ferguson et al., 1997). Racial differences have also been observed in the likelihood of receiving care from high-quality cardiac surgeons (Mukamel et al., 2000).

In a study of analgesia practices in the emergency department of a large teaching hospital, Hispanics were less likely to receive adequate analgesia for long bone fractures than white patients and were twice as likely to receive no analgesia whatsoever (Todd et al., 1993). Inadequate pain management has also been found to be significantly more likely among black nursing home patients with cancer compared with Whites (Bernabei, 1998). In multiple studies, Blacks and Hispanics with HIV infection have been found to have lower outpatient utilization and less treatment with antiretroviral medications and prophylactic medications (Andersen et al., 2000; Schwarcz, 1997; Moore et al., 1994; Easterbrook et al., 1991).

Health Outcomes

Patients seek medical care to obtain some improvement or to prevent or delay deterioration in health status. The examination of health outcomes and how they vary across subpopulations is an important tool in the evaluation of the quality of medical care. The health outcomes that can be influenced by health care include physical outcomes (death, complications, and physical functioning), patient satisfaction, and quality of life.

In a study of 1993 administrative data for 26.3 million Medicare beneficiaries over the age of 65, age and sex adjusted mortality rates were higher among black men as compared with white men (O.R = 1.19, p < 0.001) and for black women as compared with white women (O.R = 1.16, p < 0.001) (Gornick et al., 1996). Studies have shown that minorities experience higher hospitalization and mortality rates due to conditions that many providers and health services researchers agree should be preventable with appropriate outpatient management (Schwartz, 1990). Blacks experience higher rates of uncontrolled hypertension, contributing to major coronary heart disease-related events (Clark, 1999). Age-adjusted mortality rates from cervical cancer were found to be twice as high among Blacks as compared with Whites in a Chicago sample of women, and the differences remained signifi-

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