Background – We studied race-based (blacks, B vs. whites, W) trends in access to appropriate care for patients with severe aortic stenosis (SAS) and severe mitral regurgitation (SMR) at a tertiary care center from April 2019 to January 2024.

Methods – In February 2020, we implemented echocardiogram (echo) – driven EHR notifications nudging clinicians to refer patients to the Structural Heart Clinic. Inclusion and exclusion criteria are listed in Fig 1A and B. We used statistical process control (SPC) charts to show change in the endpoint over time, and an ANOVA to examine the effect of the echo date (pre and post intervention) on the log-transformed follow up (FU) time, with comparisons grouped by race. The p-values were adjusted using the Bonferroni method to account for multiple comparisons.

Results – Average time to FU decreased for both B’s and W’s (-92 and -50 days, respectively, Fig C). In the log-transformed response times (correcting for non-normal residuals), although the interaction between echo date and race was insignificant (p=0.15, ANOVA), in post-hoc subgroup analysis the intervention led to significant improvements to FU time in B’s (p=0.015, Fig D), but not for W’s. In the SPC analysis, there was a downward trend in the time to FU compared to the before “go-live” period. One explanation could be implementation of our EHR notification.

Conclusion – Such interventions might contribute to bridging race-based disparities in access to care; however, randomized studies are needed to test this hypothesis.

VIEW THE PUBLICATION

VIEW THE POSTER