{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T11:50:35Z","timestamp":1784807435039,"version":"3.55.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Timely heart failure (HF) diagnosis can lead to earlier intervention and reduced morbidity. Among historically marginalized patients, new-onset HF diagnosis is more likely to occur in acute care settings (emergency department or inpatient hospitalization) than outpatient settings. Whether inequity within outpatient clinician practices affects diagnosis settings is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We determined the setting of incident HF diagnosis among Medicare fee-for-service beneficiaries between 2013 and 2017. We identified sociodemographic and medical characteristics associated with HF diagnosis in the acute care setting. Within each outpatient clinician practice, we compared acute care diagnosis rates across sociodemographic characteristics: female versus male sex, non-Hispanic White versus other racial and ethnic groups, and dual Medicare-Medicaid eligible (a surrogate for low income) versus nondual-eligible patients. Based on within-practice differences in acute diagnosis rates, we stratified clinician practices by equity (high, intermediate, and low) and compared clinician practice characteristics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Among 315\u2005439 Medicare patients with incident HF, 173\u2005121 (54.9%) were first diagnosed in acute care settings. Higher adjusted acute care diagnosis rates were associated with female sex (6.4% [95% CI, 6.1%\u20136.8%]), American Indian (3.6% [95% CI, 1.1%\u20136.1%]) race, and dual eligibility (4.1% [95% CI, 3.7%\u20134.5%]). These differences persisted within clinician practices. With clinician practice adjustment, dual-eligible patients had a 4.9% (95% CI, 4.5%\u20135.4%) greater acute care diagnosis rate than nondual-eligible patients. Clinician practices with greater equity across dual eligibility also had greater equity across sex and race and ethnicity and were more likely to be composed of predominantly primary care clinicians.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Differences in HF diagnosis rates in the acute care setting between and within clinician practices highlight an opportunity to improve equity in diagnosing historically marginalized patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.123.010718","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T09:00:42Z","timestamp":1717750842000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Equity in the Setting of Heart Failure Diagnosis: An Analysis of Differences Between and Within Clinician Practices"],"prefix":"10.1161","volume":"17","author":[{"given":"Anshal","family":"Gupta","sequence":"first","affiliation":[{"name":"Stanford University School of Medicine, Palo Alto, CA (A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca L.","family":"Tisdale","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (R.L.T., P.A.H., A.T.S.)."},{"name":"Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (R.L.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6426-1336","authenticated-orcid":true,"given":"Jamie","family":"Calma","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (J.C., D.J.M., P.A.H., A.T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1805-1271","authenticated-orcid":true,"given":"Randall S.","family":"Stafford","sequence":"additional","affiliation":[{"name":"Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (R.S.S., D.J.M., A.T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4867-8588","authenticated-orcid":true,"given":"David J.","family":"Maron","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (J.C., D.J.M., P.A.H., A.T.S.)."},{"name":"Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (R.S.S., D.J.M., A.T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6553-3455","authenticated-orcid":true,"given":"Tina","family":"Hernandez-Boussard","sequence":"additional","affiliation":[{"name":"Department of Biomedical Data Science, Stanford University, Palo Alto, CA (T.H.-B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4563-1071","authenticated-orcid":true,"given":"Andrew P.","family":"Ambrosy","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland (A.P.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7730-8490","authenticated-orcid":true,"given":"Paul A.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (R.L.T., P.A.H., A.T.S.)."},{"name":"Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (J.C., D.J.M., P.A.H., A.T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3208-1143","authenticated-orcid":true,"given":"Alexander T.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System, Palo Alto, CA (R.L.T., P.A.H., A.T.S.)."},{"name":"Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (J.C., D.J.M., P.A.H., A.T.S.)."},{"name":"Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA (R.S.S., D.J.M., 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