Equality in Healthcare // Yusuke Tsugawa
Yusuke Tsugawa, MD, MPH, PhD is an Associate Professor of Medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at the University of California – Los Angeles (UCLA). He is also an Associate Professor of Health Policy and Management at UCLA’s Fielding School of Public Health. Prior to joining the faculty at UCLA, Tsugawa was a health specialist at The World Bank and a research fellow at Beth Israel Deaconess Medical Center/Harvard Medical School.
Iroha: Please tell us about your research.
Dr. Tsugawa: The United States healthcare system has consistently faced increasingly severe challenges due to rapid growth in healthcare spending, suboptimal quality of care, and disparities in care based on patients’ race, ethnicity, and socioeconomic status. Evidence has shown substantial geographic variations in the quality, costs, and disparities of care. However, little has been known about the ways in which individual physicians’ decisions and behaviors contribute to healthcare quality, costs, and disparities. A study conducted by my team of investigators at the Physician Quality and Innovation Lab at UCLA was the first to show that variations in costs of care among physicians, even within the same hospital, were larger than variations across hospitals (Tsugawa et al., JAMA Intern Med, 2017), thereby shedding light on the importance of individual physicians as key determinants of healthcare quality, costs, and disparities. Our team has also demonstrated that a series of physicians’ attributes—such as age, gender, and the medical school from which they graduated—are associated with the quality and cost of care, resulting in multiple publications in top peer-reviewed journals including JAMA, JAMA Intern Med, and BMJ.
Much of our team’s research has been featured by notable sources and read by many. For example, Altmetric cited one of our articles which revealed that patients of female physicians have lower mortality and readmission rates than patients of male physicians (Tsugawa et al. JAMA Intern Med, 2017). Our paper was the third most widely-read paper of the 2.2 million scientific papers published in peer-reviewed journals in 2017. Several media outlets have featured our research, including The New York Times, The Washington Post, CNN, and National Public Radio. Our research has advanced the field by highlighting systematic differences in how male and female physicians practice medicine and has led to several subsequent studies by other research teams that investigated gender differences in the practice of medicine and surgery.
Iroha: What projects are you currently working on?
Dr. Tsugawa: Our team is funded by the National Institute of Health (NIH) to identify the physician-level determinants of the quality, cost, and disparities in healthcare. Right now, we are conducting two research projects. The first research project (R01MD013913) examines surgeon factors associated with racial and ethnic disparities in surgical care and outcomes. In this study, we are evaluating whether surgeons’ medical school and residency experiences—such as the proportion of racial and ethnic minorities in their student bodies—have an impact on racial and ethnic equity in surgical care. The second research project (R01AG068633) investigates how physician and health system factors affect the quality of end-of-life (EOL) care of persons with Alzheimer’s disease and related dementias (ADRD). In this study, we are identifying key physician and health system factors associated with the quality of EOL care for persons with ADRD.
The findings from these projects would be informative to policymakers and medical educators to design interventions that could effectively improve the quality of care, reduce healthcare spending, and narrow disparity gaps throughout the US healthcare system.
Iroha: What cultural issue that is affected by race are you most interested in at the moment?
Dr. Tsugawa: I am most passionate about researching and hopefully finding solutions to end racial, ethnic, and gender disparities in healthcare quality and outcomes.