Impact of Interhospital Disparities in Cardiac Arrest Hospital Care

PROJECT ABSTRACT/SUMMARY Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in the United States, with over 350,000 OHCAs per year and a survival rate below 10%. OHCA patients from certain communities experience worse outcomes; OHCA survival rates are 40% worse for patients from African American, Hispanic/Latino, and low-income communities. However, little is known about differences in the hospital-based care that OHCA patients from these communities receive. Preliminary research suggests that differences in care exist between hospitals based on the characteristics of the patients they serve (i.e., interhospital) rather than within a hospital based on the individual characteristics of the OHCA patient. However, further research is needed to evaluate if race, ethnicity, and socioeconomic differences in care exist within or between hospitals. Additionally, no research has attempted to identify the reason behind these disparities in OHCA care and outcomes. The specific aims of Dr. Ryan Huebinger’s project are to 1) develop statistical models to identify interhospital disparities in OHCA hospital care and outcomes using a cardiac arrest database, 2) utilize Medicare claims data to perform a novel analysis evaluating differences in previously uninvestigated OHCA care modalities between hospitals and their relative impact on outcomes, and 3) interview OHCA survivors, their families, and care-providers to identify reasons for and solutions to interhospital disparities in OHCA care. This project will be the first to comprehensively evaluate interhospital disparities in OHCA care and identify reasons for disparate OHCA care between communities. Interhospital OHCA care disparities represent a novel target for real-world cardiac arrest care improvement interventions designed to deliver excellent care for all cardiac arrest patients. The applicant is dedicated to developing a career as an independent clinician-scientist focusing on OHCA disparities. As a faculty member at the University of New Mexico, he has developed strong research experience as an OHCA and prehospital medicine epidemiologist. To further his capabilities as a researcher, the training plan will allow the candidate to 1) develop an educational foundation in disparities research to better understand its complex and multi-dimensional nature, 2) become an expert in the advanced biostatistical modeling needed to disentangle the intricate web of interhospital care disparities, and 3) develop the skills essential to transition from identification of healthcare disparities to understanding and designing interventions to address healthcare disparities. The candidate has excellent institutional support and has assembled a team of invested mentors with immense experience in healthcare disparities, biostatistics, qualitative methodology, community-based research, and healthcare disparities intervention design. Through the support of this K08 award, Dr. Huebinger will obtain the necessary training and preliminary research to design a R-level proposal to study an intervention to mitigate interhospital disparities in OHCA care.