Objective:

To clarify the relationship between physician implicit racial bias and adherence to vascular care guidelines in the management of peripheral artery disease (PAD).

Approach:

• Study Design: A cross-sectional investigation utilizing data from the Society for Vascular Surgery Vascular Quality Initiative (VQI) to analyze physician implicit bias and adherence to clinical guidelines.
• Implicit Bias Measurement: Physician implicit bias was assessed using the Implicit Association Test (IAT), categorizing bias towards White or Black individuals.
• Data Collection: Data on patient treatment and physician characteristics were obtained from VQI registries covering procedures from 2011 to 2022.
• Outcome Measures: Three Class I, Level A guideline practices were evaluated: preoperative prescription of antiplatelets, statins, and antihypertensives.

Key Findings:

• Physicians with implicit bias favoring White individuals were more likely to perform low-value infrapopliteal revascularization in Black patients.
• The analysis included a total sample of 21,632 procedures and a subset of 6,588 procedures involving patients with intermittent claudication.

Interpretation:

The study seeks to establish whether structured clinical guidelines can reduce the impact of implicit racial bias on treatment decisions in PAD management.

Limitations:

• The study focused only on Black and White patients, limiting the generalizability of findings to other racial groups.
• The reliance on retrospective data may introduce biases not accounted for in the analysis.

Conclusion:

The findings will contribute to understanding how implicit bias affects clinical decision-making and the potential role of guidelines in addressing these disparities.

Sources:

• Society for Vascular Surgery Vascular Quality Initiative