https://www.archives-pmr.org/article/S0003-9993(07)01748-0/pdf

Estimating the prevalence of limb loss in the United States: 2005 to 2050.

https://uvagicases.files.wordpress.com/2013/10/cultural-differences-in-medical-communication-a-review-of-the-literature_2006_patient-education-and-counseling1.pdf

Cultural differences in medical communication: A review of the literature

It is well known that there are significant racial disparities in health care outcomes, including surgery. However, the mechanisms that lead to these disparities are still not fully understood. In this comprehensive review of the currently published surgical disparity literature in the United States, we assess racial disparities in outcomes after surgical procedures, focusing on patient, provider, and systemic factors. The PubMed, EMBASE, and Cochrane Library electronic databases were searched with the keywords: healthcare disparities AND surgery AND outcome AND US. Only primary research articles published between April 1990 and December 2011 were included in the study. Studies analyzing surgical patients of all ages and assessing the endpoints of mortality, morbidity, or the likelihood of receiving surgical therapy were included. A total of 88 articles met the inclusion criteria. This evidence-based review was compiled in a systematic manner, relying on retrospective, cross-sectional, case-control, and prospective studies in the absence of Class I studies. The review found that patient factors such as insurance status and socioeconomic status (SES) need to be further explored, as studies indicated only a premature understanding of the relationship between racial disparities and SES. Provider factors such as differences in surgery rates and treatment by low volume or low quality surgeons also appear to play a role in minority outcome disparities. Finally, systemic factors such as access to care, hospital volume, and hospital patient population have been shown to contribute to disparities, with research consistently demonstrating that equal access to care mitigates outcome disparities.

https://www.journalacs.org/article/S1072-7515(12)01379-8/pdf

Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors.

Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.

Shared Decision-making in the Medical Encounter: What Does It Mean? (Or, It Takes at Least Two to Tango)

Eight interrelated reasons for the decline of the golden age of doctoring are discussed in this article. Major extrinsicfactors (generally outside the control of the profession) include (1) the changing nature of the state and loss of its partisan support for doctoring, (2) the bureaucratization (corporatization) of doctoring; (3) the emerging competitive threat from other health care workers; (4) the consequences of globalization and the information revolution; (5) the epidemiologic transition and changes in the public conception of the body; and (6) changes in the doctor-patient relationship and the erosion of patient trust. Major intrinsic factors are (7) the weakening of physicians' labor market position through oversupply; and (8) the fragmentation or weakening of the physicians, union (AMA). Despite the recent sociopolitical transformation of modern U.S. medicine, our thinking remains wedded to a now inadequate theoretical approach. A future sociology of the professions can no longer overlook now pervasive macrostructural influences on provider behavior (corporate dominance). Until these influences are appropriately recognized and incorporated in social analyses, most policies designed to restore the professional ideal have little chance of success.

The End of the Golden Age of Doctoring

Hypothesis: Population-based hospital data indicate that African American patients undergo major lower extremity (LE) amputation 2 to 3 times more frequently than white patients. Some have attributed this to a lack of access to LE revascularization procedures by African American patients. To determine the likelihood that racial disparities in amputation rates are related to treatment choice, this study examines rates of primary amputation (major amputation without any previous attempt at revascularization) and repeat amputation. Design and Setting: Two-step case-control study, reviewing experience at a large midwestern teaching hospital. First, administrative discharge data for all 1127 patients undergoing LE arterial bypass graft, angioplasty, or major amputation from January 1, 1995, to February 1, 2000, were used to analyze racial differences in the risk of admission for major amputation vs revascularization. Medical records were then reviewed for an approximate full sample of 60 African American major amputees and a random sample of 60 (two thirds of the total) white major amputees. Racial disparities in frequency of primary and repeat amputation were analyzed, controlling for age, sex, and diabetes mellitus status. Outcome Measures: Among all patients admitted for LE ischemia, outcome measures were the odds of amputation vs revascularization, and among a sample of African American and white amputees, the odds of primary vs repeat major amputation. Results: Among all patients hospitalized for LE ischemia, African American patients were younger (P<.05), more often female (P<.01), and more likely to undergo major amputation (odds ratio, 1.68; P=.005). However, after adjusting for age, sex, and diabetes mellitus prevalence, the analysis revealed an equal likelihood of primary amputation among African Americans and whites. Repeat amputees were 2.5 times more likely to be African American than white (P=.04). Conclusion: The racial disparity at the study institution was primarily due to African American patients undergoing repeat major amputation at a significantly higher rate than whites.

https://jamanetwork.com/journals/jamasurgery/articlepdf/395906/soa2185.pdf

Explaining racial variation in lower extremity amputation: a 5-year retrospective claims data and medical record review at an urban teaching hospital.

BACKGROUND:Racial and ethnic disparities in the treatment of pain have been well documented, and there is evidence of such disparities in neuraxial analgesia use. Our objectives of this study were to analyze racial/ethnic disparities in neuraxial analgesia use, as well as anticipated use, among labo

Racial and ethnic disparities in neuraxial labor analgesia.

BACKGROUND: Experts recommend that health care providers (HCPs) collect patients’ race/ethnicity, but HCPs worry that this may alienate patients.

/pdf/patients-attitudes-toward-health-care-providers-collecting-qokvqz4fov.pdf

Patients’ attitudes toward health care providers collecting information about their race and ethnicity

The initial impact of the Medicare prospective payment system on U.S. health care: a review of the literature.

https://www.academicpedsjnl.net/article/S1876-2859(08)00261-1/pdf

Joe Feinglass

Papers

Explaining racial variation in lower extremity amputation: a 5-year retrospective claims data and medical record review at an urban teaching hospital.

Racial and ethnic disparities in neuraxial labor analgesia.

Patients’ attitudes toward health care providers collecting information about their race and ethnicity

The initial impact of the Medicare prospective payment system on U.S. health care: a review of the literature.

Family History and Parents' Beliefs About Consequences of Childhood Overweight and Their Influence on Children's Health Behaviors