Bon Secours Health System
Marriottsville, Md.

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The past several decades have witnessed tremendous advances in the treatment of all types of human disease. These breakthroughs have led to enhancements in the outcomes for patients, in terms of both quality of life and overall survival. Such improvements have not, however, been experienced uniformly by all subgroups of patients. In fact, for many illnesses, the disparity in mortality rates between white and black patients has grown wider over the past several years. For black patients, the death rates from cancer, diabetes, suicide, cirrhosis and homicide were greater in 1995 than in 1950. In 1950, the age-adjusted risk of death for heart disease for black patients was 26 percent higher than for white patients; and by 1995, this disparity had worsened to 58 percent. A striking number of papers published over the past two decades have demonstrated persistent disparate outcomes for patients of different races who undergo heart surgery.

The Bon Secours Health System cardiothoracic surgical programs participating in the system's Clinical Transformation Cardiothoracic Surgery Learning Community, which is devoted to improving outcomes for cardiothoracic surgery patients across our health system, has driven strong improvements across all five of the system's hospitals that perform cardiothoracic surgery.

One of the system's five hospitals that is heavily invested in the care of African-American patients in Hampton Roads, Va., demonstrated equal outcomes for all cardiac surgery patients, regardless of race. A detailed analysis of this program was undertaken, in an effort to understand how disparities were avoided in a population otherwise at high risk for suboptimal outcomes. Critical components for leveraging equal outcomes for all patients seem to include, but are not limited to, pre-surgical intensive case management for optimal preparation followed by intensive pre-discharge and post-discharge follow-up.

The cardiothoracic surgery learning community analysis allowed Bon Secours to develop a model of practice that seeks to identify those elements of patient and health-system interactions essential to the successful delivery of health care without disparities. It is hoped that such a model will prove useful in eradicating health disparities in cardiovascular surgery in other programs, and that it may prove useful in other areas of medical practice beyond surgery which are experiencing race-based disparate outcomes.

Bon Secours clinicians and staff, as part of living the organization's mission, have a clear ethical duty to treat all patients equally, regardless of personal attributes or characteristics. The opportunity to achieve equity in health care for our cardiothoracic surgical patients continues to be evaluated for key drivers of health disparities, causative mechanisms for unequal medical outcomes, and pursuit of appropriate personal and organizational initiatives which assure equal quality of medical care for all.