Browsing by Author "Hebdon, Megan"

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    Association between clinician team segregation, receipt of cardiovascular care and outcomes in valvular heart diseases
    (Wiley, 2025) Bolakale-Rufai, Ikeoluwapo Kendra; Knapp, Shannon M.; Bisono, Janina Quintero; Johnson, Adedoyin; Moore, Wanda; Yankah, Ekow; Yee, Ryan; Trabue, Dalancee; Nallamothu, Brahmajee; Hollingsworth, John M.; Watty, Stephen; Williamson, Francesca; Pool, Natalie; Hebdon, Megan; Ezema, Nneamaka; Capers, Quinn; Blount, Courtland; Kimbrough, Nia; Johnson, Denee; Evans, Jalynn; Foree, Brandi; Holman, Anastacia; Lightbourne, Karen; Brown, David; Tucker Edmonds, Brownsyne; Breathett, Khadijah; Medicine, School of Medicine
    Aims: Racial disparities exist in clinical outcomes for valvular heart disease (VHD). It is unknown whether clinician segregation contributes to these disparities. Among an adequately insured population, we evaluated the relationship between clinician segregation in a hospital and receipt of care by a cardiologist according to patient race. We also evaluated the association between clinician segregation, race and care by a cardiologist on 30-day readmission and 1-year survival. Methods and results: Using Optum's Clinformatics® Data Mart Database (CDM, US commercial and Medicare beneficiaries) from 2010 to 2018, we identified patients with a primary diagnosis of VHD. Hospitals were categorized into low, medium and high segregation groups (SG), according to clinician segregation index (SI). SI can range from 0-1 (0: the ratio of Black to White patients is the same for all clinicians; 1: each clinician treats only Black or only White patients). Outcomes were analysed using generalized linear mixed effect models. Among 8649 patients [median age 75 (67-82), 45.4% female, 16.1% Black, 83.9% White], odds of care from a cardiologist did not vary across race for all SGs [Low SG adjusted odds ratio (aOR): 0.79 (95% CI: 0.58-1.08), P = 0.14; Medium SG aOR: 0.86 (95% CI: 0.60-1.25), P = 0.43; High SG aOR: 1.07 (95% CI: 0.68-1.69), P = 0.76]. Among those that received care from a cardiologist, there was no difference in the 30-day readmission between Black and White patients across SGs [Low SG aOR: 1.05 (95% CI: 0.83-1.31), P = 0.70; Medium SG aOR: 1.22 (95% CI: 0.92-1.61), P = 0.17; High SG aOR: 0.81 (95% CI: 0.57-1.17), P = 0.27]. Among patients that did not receive care from a cardiologist, Black patients in low SG had higher odds of 30-day readmission compared to White patients [aOR: 2.74 (95%CI:1.38-5.43), P < 0.01]. Odds of 1-year survival were similar across race for all SG irrespective of receipt of care from a cardiologist [seen by a cardiologist: Low SG aOR: 1.13 (95% CI: 0.86-1.48), P = 0.38; Medium SG aOR: 0.83 (95% CI: 0.59-1.17), P = 0.29; High SG aOR: 1.01 (95% CI: 0.66-1.52), P = 0.98; not seen by a cardiologist: Low SG aOR: 0.56 (95% CI: 0.23-1.34), P = 0.19; Medium SG aOR: 0.81 (95% CI: 0.28-2.37), P = 0.70; High SG aOR: 0.63 (95% CI: 0.23-1.74), P = 0.37]. Conclusions: Among an insured population, race was not associated with care by a cardiologist for VHD or survival. Black patients not seen by cardiologists had higher odds of 30-day readmission in low clinician SG.
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    Race and Gender-Based Perceptions of Older Adults: Will the Youth Lead the Way?
    (Springer Nature, 2021) Solola, Sade; Luy, Luis; Herrera-Theut, Kathryn; Zabala, Leanne; Torabzadeh, Elmira; Bedrick, Edward J.; Yee, Erika; Larsen, Ashley; Stone, Jeff; McEwen, Marylyn; Calhoun, Elizabeth; Crist, Janice D.; Hebdon, Megan; Pool, Natalie; Carnes, Molly; Sweitzer, Nancy; Breathett, Khadijah; Medicine, School of Medicine
    Background: Older individuals encounter the greatest racial/gender biases. It is unknown whether younger generations, who often lead culture shifts, have racial and gender biases against older populations. Methods: Using Amazon's Mechanical Turk's crowdsourcing, we identified how an individual's race and gender are associated with perceptions of individuals aged mid-60s. Participants were asked to rate photograph appearances on Likert Scale (1-10). Interactions between participant and photograph race and gender were assessed with mixed effects models. Delta represents rating differences (positive value higher rating for Whites or women, negative value higher rating for African-Americans or men). Results: Among 1563 participants (mean 35 years ± 12), both non-Hispanic White (WP) and all Other race/ethnicity (OP) participants perceived African-American photos as more trustworthy [Delta WP -0.60(95%CI-0.83, - 0.37); Delta OP - 0.51(- 0.74,-0.28), interaction p = 0.06], more attractive [Delta non-Hispanic White participants - 0.63(- 0.97, - 0.29); Delta Other race/ethnicity participants - 0.40 (- 0.74, - 0.28), interaction p < 0.001], healthier [Delta WP -0.31(- 0.53, - 0.08); Delta OP -0.24(- 0.45, -0.03), interaction p = 1.00], and less threatening than White photos [Delta WP 0.79(0.36,1.22); Delta OP 0.60(0.17,1.03), interaction p < 0.001]. Compared with OP, WP perceived African-American photos more favorably for intelligence (interaction p < 0.001). Both genders perceived photos of women as more trustworthy [Delta Women Participants (WmP) 0.50(0.27,0.73); Delta Men Participants(MnP) 0.31(0.08,0.54); interaction p < 0.001] and men as more threatening [Delta WmP -0.84(-1.27, -0.41), Delta MnP - 0.77(- 1.20, - 0.34), interaction p = 0.93]. Compared with MnP, WmP perceived photos of women as happier and more attractive than men (interaction p < 0.001). Compared with WmP, MnP perceived men as healthier than women (interaction p < 0.001). Conclusions: Among a young generation, older African-Americans were perceived more favorably than Whites. Gender perceptions followed gender norms. This suggests a decline in implicit bias against older minorities, but gender biases persist. Future work should investigate whether similar patterns are observed in healthcare.
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    Relationship Between Health Care Team Segregation and Receipt of Care by a Cardiologist According to Patient Race in a Midwestern State
    (American Heart Association, 2025) Quintero Bisonó, Janina; Knapp, Shannon M.; Trabue, Dalancee; Yee, Ryan; Williamson, Francesca; Johnson, Adedoyin; Watty, Stephen; Pool, Natalie; Hebdon, Megan; Moore, Wanda; Yankah, Ekow; Ezema, Nneamaka; Kimbrough, Nia; Lightbourne, Karen; Tucker Edmonds, Brownsyne; Capers, Quinn; Brown, David; Johnson, Denee; Evans, Jalynn; Foree, Brandi; Holman, Anastasia; Blount, Courtland; Nallamothu, Brahmajee; Hollingsworth, John M.; Breathett, Khadijah; Medicine, School of Medicine
    Background: Segregation index (SI) has been associated with worsened health. However, the relationship between SI within health care teams (degree of heterogeneity between teams caring for Black compared with White patients) and cardiovascular care is unclear among adequately insured populations. We sought to assess the relationship between health care team SI, patient race, receipt of care by a cardiologist, 1-year survival, and 30-day readmission rates for Black compared with White patients admitted with heart failure, ischemic heart disease, or valvular heart disease. Methods: Using Optum's de-identified Clinformatics Data Mart Database (CDM) from 2009 to 2020, generalized linear mixed-effects were used to analyze effects of patient race and SI on receipt of care by a cardiologist, and care by a cardiologist on 1-year survival and 30-day readmission. Results: Among 6572 patients (17.1% Black), the odds of receiving care by a cardiologist were 31.3% less for Black than White patients (adjusted odds ratio 0.687 [95% CI, 0.545-0.872]; P=0.001). However, there was no statistically significant association of SI on receipt of care by a cardiologist (P=0.14). For those seen by a cardiologist, the adjusted odds ratio (Black-to-White) of 1-year survival increased with increasing SI (P=0.02). SI had no statistically significant effect on 30-day readmission (P=0.86). Conclusions: Among patients hospitalized for heart failure, ischemic heart disease, or valvular heart disease, segregation of health care teams was not associated with receipt of care by cardiologists in Indiana hospitals. When cardiologists were included, the odds of 1-year survival increased for Black versus White patients with increasing segregation of clinicians, and segregation was not associated with 30-day readmission.