Author ORCID Identifier

0000-0002-1723-4204

Defense Date

2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Services Organization and Research

First Advisor

Dr. Jan Clement

Second Advisor

Dr. Gloria Bazzoli

Third Advisor

Dr. Bassam Dahman

Fourth Advisor

Dr. Anna Lin

Abstract

Immediate Breast Reconstruction Surgery (IBRS) is associated with better quality of life among women who undergo a mastectomy. Despite insurance coverage for IBRS, utilization of IBRS remains low. Data from publicly available sources for 2010-2012 are used to examine the association between hospital characteristics receipt of IBRS by patients. Minority-serving status, low bed size, for-profit ownership, non-teaching status, high competition, low density of plastic surgeons in the market and non-metropolitan location are associated with lower likelihood of receipt of IBRS.

Racial and ethnic minorities are less likely to receive IBRS. A mixed effects logistic regression model with interactions between Black/Hispanic race/ethnicity and hospital variables is estimated to examine whether certain hospital characteristics are associated with disparately low receipt of IBRS for racial and ethnic minorities. Minority-serving hospitals located in markets with a higher density of plastic surgeons and higher competition characteristics are associated with disparately low receipt of IBRS for racial and ethnic minorities.

In order to reduce racial/ ethnic differences in receipt of IBRS, it is important to understand which factors contribute the most to these differences. Fairlie decomposition is used to examine the contribution of multi-level factors to racial and ethnic differences in receipt of IBRS. Racial and ethnic differences in being Medicaid insured, residing in low-income neighborhoods and receiving care at minority-serving hospitals are the three largest contributors to racial and ethnic differences in receipt of IBRS. The results from this study have significant implications for access to IBRS among racial and ethnic minority patients.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

7-13-2017