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Michelle van Ryn, PhD, MPH, Diana Burgess, PhD, Jennifer Malat, PhD and Joan Griffin, PhD

Michelle van Ryn is with the Department of Family Practice and Community Health, University of Minnesota Medical School; the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis; and the Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center. Diana Burgess and Joan Griffin are with the Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, and the Department of Medicine, University of Minnesota Medical School. Jennifer Malat is with the Department of Sociology, University of Cincinnati, Cincinnati, Ohio.

Correspondence: Requests for reprints should be sent to Michelle van Ryn, PhD, MPH, Department of Family Practice and Community Health, University of Minnesota, Room 225 Dinnaken Building, 925 Delaware St SE, Minneapolis, MN 55414 (e-mail: vanry001{at}umn.edu).

Objectives. A growing body of evidence suggests that provider decisionmaking contributes to racial/ethnic disparities in care. We examined the factors mediating the relationship between patient race/ethnicity and provider recommendations for coronary artery bypass graft surgery.

Methods. Analyses were conducted with a data set that included medical record, angiogram, and provider survey data on postangiogram encounters with patients who were categorized as appropriate candidates for coronary artery bypass graft surgery.

Results. Race significantly influenced physician recommendations among male, but not female, patients. Physicians’ perceptions of patients’ education and physical activity preferences were significant predictors of their recommendations, independent of clinical factors, appropriateness, payer, and physician characteristics. Furthermore, these variables mediated the effects of patient race on provider recommendations.

Conclusions. Our findings point to the importance of research and intervention strategies addressing the ways in which providers’ beliefs about patients mediate disparities in treatment. In addition, they highlight the need for discourse and consensus development on the role of social factors in clinical decisionmaking.