Evaluating Disparities in Neurological Clinical Decision Making by Race/Ethnicity: Utilizing a Scorecard to Assess Local Practice Patterns
Roshni Dhoot1, Deborah Rose1, Shakthi Unnithan2, Danelvis Paredes3, Meenakshi Roy4, C. Hunter Roark1, Petra Brayo5, Hussein Al-Khalidi2, Andrew Spector1
1Department of Neurology, 2Department of Biostatistics & Bioinformatics, Duke University, 3Department of Neurology, University of California San Francisco, 4Department of Neurology, Rush University Medical Center, 5University of Pittsburgh Medical Center
Objective:
Personalized data could benefit clinicians seeking to ensure equity in their clinical decisions. A scorecard is a convenient way to communicate this information both to clinician and to the communities in which they practice.
Background:
Racial/ethnic health disparities are common throughout Neurology, and clinical decisions contribute to these disparities.
Design/Methods:
One binary clinical decision point was analyzed for each division within an academic neurology center. The percentage of patients who received each intervention was stratified by race/ethnicity and compared to identify any disparities in care.
Results:
There was a statistically significant disparity between Black and White patients in treatment of acute ischemic stroke with White patients about 30% more likely to receive alteplase than Black patients. There was also a disparity in patients with epilepsy with non-Hispanic patients being roughly 5 times more likely than Hispanic patients to be referred to Neurosurgery, with an estimated OR=4.9 and 95% CI (2.1,11.6). No other disparities were identified. This resulted in scored grades of 5 As and 2 Bs.
Conclusions:
The use of a scorecard to report disparities data can provide incentive for clinicians to investigate their practices for causes of the disparities while building trust and transparency with their communities.