Washington, D.C.—Sanjay Prasad, MD, FACS, author of Resetting Healthcare Post-COVID-19 Pandemic: The Patient Handbook, has identified a solution for racial disparities in surgical outcomes. Dr. Prasad's book educates the reader the current state of healthcare and offers a plausible solution as we move into the post-pandemic world.
His research led him to ask another question: Are the outcomes for black and Hispanic patients different than white patients when it comes to surgery? The answer is an astounding, yes. Are the differences related to other factors such as socioeconomic class, insurance status, gender, income, extent of disease at presentation or other co-morbidities? Surprisingly, even when controlling for many of these factors, racial disparities persist.
The solution, SurgiQuality uses a personalized concierge service and HIPAA-compliant technology to empower patients with tools to compare surgeons based on past outcomes, so they can make well-informed decisions.
SurgiQuality
Here are some of the racial disparities that were uncovered in his research:
In 2013 Dr. Adil Haider and team reviewed 88 articles on the subject of racial disparities in surgical outcomes. Consider the following excerpts from their review:
• Ricciardi et al's nationwide study of appendectomy, gastric fundoplication, and gastric bypass surgeries found that black patients were significantly more likely to die in-hospital than white patients (2.6 per 1000 patients versus 1.6 per 1000 patients, p< 0.05).
• In an analysis of the effect of gender on outcomes of lower extremity arterial disease, Vouyouka et al. showed that female gender increased the odds of mortality among black patients specifically (OR 1.20, 95% CI 1.11–1.30)
• Larger disparities are noted in higher risk surgeries; an analysis of the Nationwide Inpatient Survey showed that mortality, among anterior cervical spine surgery patients, was 1.57 times higher for black patients than for white patients, despite adjusting for age, insurance status, and geographic region.
• Black men over 65 years of age less frequently received abdominal aortic aneurysm (AAA) repair compared to white men despite higher disease prevalence.
• Racial outcome inequities continue to be observed when controlling for insurance status. For instance, in one study of patients undergoing major hepatectomy (liver resection), black patients had 2.15 times higher odds than white patients of death after surgery, despite controlling for insurance status, clinical and hospital factors (95% CI 1.28–3.57).
Solutions
Awareness
Clearly awareness amongst primary care physicians, surgeons, and nurses is an important first step. Publishing findings from Haider's group and others regarding racial disparities in surgery within professional journals would go a long way. Presentation of these topics at professional society meetings would increase awareness, foster discussion and hopefully lead to specialty-specific recommendations to combat these problems.
Behavioral Modification
The next logical step is behavioral modification especially as it relates to provider communication. Physicians and surgeons need to better ascertain the education level of their patients and tailor their discussions, accordingly, using understandable language to break down complex aspects of their condition with use of analogies. A plumber, for example, can easily understand salient features of the circulatory system, if the discussion relates to pipes leading to and away from the pump. Insisting on presence of family members (even by phone) at office visits, would go a long way to ensure comprehension. Asking patients to repeat what was stated about their condition and treatment options reinforces patient comprehension.
Concierge Service and Technology
Consider the surgical process today. Patients are referred from their primary care physician to a surgeon without much thought about the cost of care or about the surgeon's experience related to the patient's condition. The result is that patients are pigeonholed to one surgeon. They have a provider book of surgeons in their network, to choose from but no way to choose the best surgeon for the complexity of their condition.
A concierge and technology service like SurgiQuality can help. Once patients are told they need surgery, a personalized concierge helps gather and upload their medical records and imaging studies to the HIPAA-compliant cloud. From here the records are sent to multiple board-certified surgeons through SurgiConnect platform.
Herein lies a powerful solution because the records are blinded with regard to race and ethnicity. After review, surgeons validate medical necessity and enter their past experience with that case, such as number of cases performed the previous year, success and complication rates. The experience data is verified, compared with the group of reporting surgeons and assigned a star grade of 1-5 stars. Surgeons with their facility also report all-inclusive pricing.
Through peer review of their case, patients avoid unnecessary surgery and learn of alternatives to surgery. When their surgery is necessary, patients can choose their surgeon from their in-network provider book, based on the surgeon's past experience with their procedure. The concierge is there every step of the way to ensure patients understand the quality outcomes measures.
In summary, racial disparities in surgical care delivery do exist, even when we control for other factors such as socioeconomic class, insurance status, gender, income, extent of disease at presentation or other co-morbidities. Provider awareness is a key initial step to increase awareness followed by enhanced communication with the patient, with family involvement whenever possible.
SurgiQuality helps handhold patients as their records are sent to multiple surgeons within their network. These cases are presented without race and ethnicity demographic information. Using the system, surgeons make decisions more objectively and patients are empowered with tools to make well-informed decisions.
Dr. Prasad has been a practicing surgeon for nearly thirty years in the super-specialized field of otology, neurotology, and skull base surgery, a subspecialty within otolaryngology head and neck surgery (ENT). Prasad is one of the few surgeons in his specialty to complete three fellowships in neurotology, advanced head and neck oncologic surgery, and cranial base surgery. He is an assistant clinical professor at George Washington University and the founder of SurgiQuality. His thirty years as a surgeon has given him deep insight into the flaws in the surgery referral process.
"I want people to realize that we have a serious quality issue in medicine today," says Dr. Prasad. "The healthcare system must be held accountable. I firmly believe that SurgiQuality plays a key role in helping patients regain control of the healthcare process, empowering them with the tools to make well-informed, health-positive decisions."
Resetting Healthcare Book Trailer
Resetting Healthcare Post-COVID-19 Pandemic: The Patient Handbook, ISBN-10: 1737199416 ISBN-13: 978-1737199410, Sanjay Prasad, MD, FACS, available at Amazon.
Sanjay Prasad, MD, FACS, has been a practicing surgeon for nearly thirty years in the super-specialized field of otology, neurotology, and skull base surgery, a subspecialty within otolaryngology head and neck surgery (ENT). Prasad is one of the few surgeons in his specialty to complete three fellowships in neurotology, advanced head and neck oncologic surgery, and cranial base surgery. He is an assistant professor at George Washington University.
As a medical director for an ambulatory surgery center, he was one of the first to start bundling surgical services for all-inclusive prices in 2014. In the same year, Prasad founded SurgiQuality, with a mission to help surgical patients connect to best-in-class surgeons who operate in a cost-efficient environment.
He is the author of Resetting Healthcare, which examines the lack of transparency in surgical care and offers SurgiQuality as a solution. Prasad practices and lives in the Washington, DC, area with his amazing wife, Deepika, and their four very accomplished adult children, Meghna, Kiran, Neha, and Dilan.
You can find more information on Dr. Sanjay Prasad and Resetting Healthcare at www.resettinghealthcare.com.
Media Contact: For a review copy of Resetting Healthcare or to arrange an interview with Dr. Sanjay Prasad, contact Scott Lorenz of Westwind Communications Book Marketing at scottlorenz@westwindcos.com or by phone at 734-667-2090. Follow Lorenz on twitter @abookpublicist