![]() ![]() 25 This study was guided by Public Health Critical Race Praxis, an approach utilized by researchers to study and ameliorate instances of structural racism and resultant health inequities and developed out of the legal framework of Critical Race Theory. The committee also wished to test a hypothesis that leading with a racial equity analysis would uncover additional structural inequities, which could be addressed intersectionally. The committee chose to focus on patients admitted with HF because this is the most frequent medical admission diagnosis at our institution, the second most common reason for hospital admission in the United States among older adults, 24 and a condition for which there are known racial inequities in outcomes. This analysis was one of the first projects undertaken by our institution’s Department of Medicine Health Equity Committee, a multidisciplinary group formed in 2017 to identify and address health equity concerns. To address this hypothesis, we performed a single-center retrospective cohort study of patients admitted with a principal diagnosis of HF for a 10-year period to evaluate the relationship between race and admission service assignment, as well as the subsequent relationship between admission service and outcomes. We hypothesized that at our institution, there was inequitable access to the cardiology service for patients admitted with HF and that this inequity could contribute to the previously mentioned racial inequities in HF outcomes. ![]() 18–23 This beneficial outcome may result from a combination of access to cardiology expertise and improved care, and additional supports found on cardiology services (eg, specialty nursing, pharmacy, postdischarge services). Observational studies have found that patients receiving specialty cardiology care during an admission for HF have superior outcomes, including lower readmission rates and mortality. Patients on GMS may receive a cardiology consult, but this is uncommon at our institution. 17Īt our institution, patients admitted with HF may be primarily cared for by a hospitalist (on the general medicine service ) or cardiologist (on the cardiology service). 5–10 Some studies suggest that racial inequities in HF care are driven by between-hospital quality differences in the setting of de facto health facility segregation for minority patients, 11–16 although there is recent evidence that these differences are derived from a systemic, rather than hospital-specific, effect. 4 Racial inequities in mortality and readmission rates for patients with heart failure (HF) have been widely documented. 3 Health disparities are differences in health outcomes between groups within a population, whereas health inequities are differences in health outcomes that are systematic, avoidable, and unjust. 2 Structural racism in the United States is a major impediment to achieving health equity-the opportunity for all people to achieve their full health potential. 1 This is, in part, driven by the differential access to the goods, services, and opportunities of society by race, which has been termed structural racism. Inequitable quality of healthcare and access to healthcare by race is a well-documented phenomenon in the United States.
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