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Objectives: The purpose of this study was to examine the effect of race on whether or not a patient would accept an invasive cardiac procedure when referred by a physician., Methods: A retrospective longitudinal review of medical records at a public health hospital in southeastern Louisiana was conducted to determine cardiovascular patient acceptance/ rejection differences. Patient charts were examined using specific indicators (type of pain, laboratory values, blood pressure, and radiographic tests) to determine which patients were eligible to be referred. In order to be selected, each medical record had to have documentation of a physician referral for an invasive cardiac procedure. Medical charts without this referral were deemed ineligible for the cohort., Results: Patient preferences were similar for both minorities and Caucasians, despite the fact that the study controlled for disease severity, age, income, sex, race, social support, diagnosis, and family history., Conclusion: Race did not contribute to disparate acceptance and rejection rates among African Americans and Caucasians. A possible reason for this occurrence is that the site was a teaching hospital, which may indicate more physician oversight and better articulation of treatment options. Future studies should delve deeper into physician and institutional bias in non-teaching facilities during patient/physician interactions.

Objectives: The purpose of this study was to examine physician bias when patients present with cardiovascular disease in a teaching hospital that treats a majority of African American patients. Physician bias was deemed to occur when cardiovascular disease patients did not receive an invasive procedure when needed., Methods: The hospital in the study was a teaching facility in southeastern Louisiana. We conducted a longitudinal retrospective review of 177 medical records from patients with cardiovascular disease. Patient charts were examined using specific indicators (type of pain, lab work, blood pressure, and x-ray tests) from the Framingham study (1996) to determine whether patients met the criteria for eligibility of invasive procedures, such as percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) and if so, whether they were referred accordingly. Next, these charts were used to obtain confounders (race, sex, income, age, disease severity, and diagnoses) from each patient. Finally, a logistic regression analysis was used to determine the effect of these confounders on a patient being referred by a physician., Results: The model failed to find a statistically significant disparity between physician referrals for African Americans and Caucasians when cardiovascular disease patients met specific criteria. Therefore, physician referral disparities did not exist among this study population. This occurred despite the fact that the study controlled for primary diagnoses, disease severity, age, income, sex, and race., Conclusion: This research concludes that physicians' referral patterns for cardiac procedures were similar for both African Americans and Caucasians. Moreover, this research suggests that referral disparities may not exist at teaching hospitals that serve a majority of African American patients. Future studies should delve deeper into physician/patient interaction at these institutions to understand what they do to reduce disparities in the hope of implementing their methods at other hospitals.

The purpose of this study was to investigate racial and gender differences in the utilization of invasive procedures for cardiovascular treatment. Medical records data of 3015 patients were abstracted from a Medical System Database from 1999 to 2001. Logit models were used to estimate the adjusted odds in the utilization, referral, and acceptance of invasive procedures, while controllingfor confounders (age, race, sex, comorbidity, disease severity, payer type, marital status and family history) simultaneously. When considering utilization of invasive procedures, the adjusted odds were lower for African-Americans compared to Caucasians. There was a statistically significant difference (p < .05) in Coronary Artery Bypass Graft (CABG) utilization between African Americans and Caucasians. African Americans were less likely than Caucasians to receive a CABG. Although not statistically significant, African-Americans were less likely than Caucasians to receive a cardiac catheterization and Percutaneous Transluminal Coronary Angioplasty (PTCA). Findings failed to yield a statistical significance for gender disparities regarding invasive procedure utilizations.

This study estimates the number of AIDS orphans in Louisiana and projects the fiscal demand on the state's foster care system in the year 2000. The Michaels and Levine model is used to estimate the number of orphans, and state foster care data are used to project the placement cost of those AIDS orphans. Between 1992 and the year 2000, the AIDS orphan count in Louisiana is estimated to range between 1,242 and 2,627 infants and children. Black children are estimated to comprise the overwhelming majority of this population. If only 50% of the AIDS orphans this study projects for the year 2000 require foster care services, the state of Louisiana would need additional revenues for that year alone, ranging from $308,112 to $624,546, to serve those new entrants. This study provides a critical starting point for state policy planning. The AIDS orphan population in Louisiana is growing each year and the needs of these infants and children must be anticipated and accommodated.

This article presents a study that identifies cost issues and strategies in a highly competitive hospital service area. Specifically, the study seeks to determine the most important cost issues that are currently facing hospitals and to examine the effectiveness of various cost containment strategies. Additionally, the study examines the extent of agreement among hospitals regarding the effectiveness of cost containment strategies. The current study focused on all private hospitals in the Baton Rouge service area. A high degree of consensus was found regarding the importance of cost issues in the service area. One of the more significant findings was the strong agreement that physician involvement (in the category of physician use of resources) was the most important cost issue facing hospitals in the Baton Rouge service area. The group of cost containment strategies with the greatest success related to the issue of budgeting and patient accounts. In particular, electronic billing and the use of collection agencies were favored.