scholarly journals P090: A scoping review on patient race, ethnicity, and care in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S96
Author(s):  
A. Owens ◽  
B. Holroyd ◽  
P. McLane
Keyword(s):  
United States ◽  
Emergency Department ◽  
Ethnic Groups ◽  
Scoping Review ◽  
Race And Ethnicity ◽  
Diagnostic Testing ◽  
The United States ◽  
Wait Times ◽  
Patient Race ◽  
The Impact

Introduction: Health disparities between racial and ethnic groups have been well documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there is a lack of scientific reviews in this important area. The objective of this review is to provide an overview of the literature on the impact of patient race and ethnicity on ED care. Methods: A scoping review guided by the framework described by Arksey and O'Malley was undertaken. This approach was taken because it was best suited to the goal of providing an overview of all of the literature, given the broad nature of the topic. All studies with primary outcomes considering the impact of patient race and ethnicity on “throughput” factors in the ED as defined by Asplin et al., were considered. Outcomes considered included triage scores, wait times, analgesia, diagnostic testing, treatment, leaving without being seen, and patient experiences. Literature from Canada, the United States, Australia, and New Zealand was considered. A database search protocol was developed iteratively as familiarity with the literature developed. Inclusion and exclusion decisions were made using an established model. Results: The original search yielded 1157 citations, reduced to 453 after duplicate removal. 153 full texts were included for screening, of which 85 were included for final data extraction. Results indicate there is evidence that minority racial and ethnic groups experience disparities in triage scores, wait times, analgesia, treatment, diagnostic testing, leaving without being seen, and subjective experiences. Authors’ suggested explanations for these disparities can be placed in the following categories: (1) communication differences; (2) conscious or unconscious bias; (3) facility and resource factors in hospitals with higher minority presentation rates; and (4) differences in clinical presentations. Conclusion: This scoping review provides an overview of the literature on the impacts of race and ethnicity on ED care. As disparities have been shown to exist in numerous contexts, further research on the impact of race and ethnicity in ED care is warranted, especially in the Canadian literature. Such explorations could aid in the informing and creation of policy, and guide practice.

scholarly journals Patient race, ethnicity, and care in the emergency department: A scoping review

CJEM ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 245-253 ◽  
Author(s):  
Allison Owens ◽  
Brian R. Holroyd ◽  
Patrick McLane
Keyword(s):  
Emergency Department ◽  
Scoping Review ◽  
Race And Ethnicity ◽  
Research Question ◽  
The United States ◽  
Subjective Experiences ◽  
Patient Race ◽  
Abstract Screening ◽  
The Impact ◽  
Full Text Screening

ABSTRACTObjectivesHealth disparities between racial and ethnic groups have been documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there are no comprehensive literature reviews in this area. The objective of this review is to provide an overview of the literature on the impact of patient ethnicity and race on the processes of ED care.MethodsA scoping review was conducted to capture the broad nature of the literature. A database search was conducted in MEDLINE/PubMed, EMBASE, CINAHL Plus, Social Sciences Citation Index, SCOPUS, and JSTOR. Five journals and reference lists of included articles were hand searched. Inclusion and exclusion criteria were defined iteratively to ensure literature captured was relevant to our research question. Data were extracted using predetermined variables, and additional extraction variables were added as familiarity with the literature developed.ResultsSearching yielded 1,157 citations, reduced to 153 following removal of duplicates, and title and abstract screening. After full-text screening, 83 articles were included. Included articles report that, in EDs, patient race and ethnicity impact analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient subjective experiences. Authors of included studies propose a variety of possible causes for these disparities.ConclusionsFurther research on the existence of disparities in care within EDs is warranted to explore the causes behind observed disparities for particular health conditions and population groups in specific contexts.

scholarly journals Emergency Department Visit Rates for Motor Vehicle Crashes by Selected Characteristics in the United States, 2017-2018

2021 ◽  
Author(s):  
Danielle Davis ◽  
Christopher Cairns
Keyword(s):  
United States ◽  
Emergency Department ◽  
Emergency Department Visit ◽  
Race And Ethnicity ◽  
Motor Vehicle ◽  
The United States ◽  
Motor Vehicle Crashes ◽  
Insurance Status ◽  
Vehicle Crashes ◽  
Health Insurance Status

This report presents emergency department visit rates for motor vehicle crashes by age, race and ethnicity, health insurance status, and region.

Success Stories (DRAFT)

2018 ◽  
Author(s):  
Boaz Ronen ◽  
Joseph S Pliskin ◽  
Shimeon Pass
Keyword(s):  
United States ◽  
Emergency Department ◽  
United Kingdom ◽  
Emergency Room ◽  
The United States ◽  
Healthcare Systems ◽  
Theory Of Constraints ◽  
Wait Times ◽  
Success Stories ◽  
Specific Contribution

This chapter describes some success stories that show how the tools, methods, and philosophies were used in a variety of healthcare systems. The cases presented here include successful implementations in the United States, United Kingdom, and Israel. Each story highlights the objectives and the results of the organization. Objectives include reducing emergency room wait times, reducing delayed admissions, improving emergency department and operating room throughput, improving quality and customer satisfaction. Although the cases use a variety of methods, approaches include eliminating dummy constraints, using specific contribution for prioritization, and working with complete kits, focusing on the theory of constraints, and reducing work in progress.

scholarly journals The Impact of the “Muslim Ban” Executive Order on Healthcare Utilization in Minneapolis-St. Paul, Minnesota

2020 ◽  
Author(s):  
Elizabeth A. Samuels ◽  
Lilla Orr ◽  
Elizabeth B. White ◽  
Altaf Saadi ◽  
Aasim I. Padela ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Emergency Department ◽  
Healthcare Utilization ◽  
The United States ◽  
Emergency Department Visits ◽  
Executive Order ◽  
Before And After ◽  
Muslim Majority ◽  
The Impact

AbstractObjectiveDetermine whether the 2017 “Muslim Ban” Executive Order impacted healthcare utilization by people born in Order-targeted nations living in the United States.MethodsWe conducted a retrospective cohort study of people living in Minneapolis-St. Paul, MN in 2016-2017 who were: 1) born in Order-targeted nations, 2) born in Muslim-majority nations not listed in the Order, and 3) born in the United States and non-Latinx. Primary outcomes were: 1) primary care visits, 2) missed primary care appointments, 3) primary care diagnoses for stress-responsive conditions, 4) emergency department visits, and 5) emergency department visits for stress-responsive diagnoses. We evaluated visit trends before and after Order issuance using linear regression and differences between study groups using a difference-in-difference analyses.ResultsIn early 2016, primary care visits and stress-responsive diagnoses increased among individuals from Muslim majority nations. Following the Order, there was an immediate increase in emergency department visits among individuals from Order-targeted nations.ConclusionsIncreases in healthcare utilization among people born in Muslim majority countries before and after the “Muslim Ban” likely reflect elevated cumulative stress including the impact of the Order.

scholarly journals COVID-19 Misinformation Prophylaxis: Protocol for a Randomized Trial of a Brief Informational Intervention (Preprint)

2020 ◽  
Author(s):  
Jon Agley ◽  
Yunyu Xiao ◽  
Esi E Thompson ◽  
Lilian Golzarri-Arroyo
Keyword(s):  
United States ◽  
Randomized Trial ◽  
Race And Ethnicity ◽  
Face Mask ◽  
The United States ◽  
Placebo Control ◽  
Preventive Behaviors ◽  
Institutional Review ◽  
Superiority Trial ◽  
The Impact

BACKGROUND As the COVID-19 pandemic continues to affect life in the United States, the important role of nonpharmaceutical preventive behaviors (such as wearing a face mask) in reducing the risk of infection has become clear. During the pandemic, researchers have observed the rapid proliferation of misinformed or inconsistent narratives about COVID-19. There is growing evidence that such misinformed narratives are associated with various forms of undesirable behavior (eg, burning down cell towers). Furthermore, individuals’ adherence to recommended COVID-19 preventive guidelines has been inconsistent, and such mandates have engendered opposition and controversy. Recent research suggests the possibility that trust in science and scientists may be an important thread to weave throughout these seemingly disparate components of the modern public health landscape. Thus, this paper describes the protocol for a randomized trial of a brief, digital intervention designed to increase trust in science. OBJECTIVE The objective of this study is to examine whether exposure to a curated infographic can increase trust in science, reduce the believability of misinformed narratives, and increase the likelihood to engage in preventive behaviors. METHODS This is a randomized, placebo-controlled, superiority trial comprising 2 parallel groups. A sample of 1000 adults aged ≥18 years who are representative of the population of the United States by gender, race and ethnicity, and age will be randomly assigned (via a 1:1 allocation) to an intervention or a placebo-control arm. The intervention will be a digital infographic with content based on principles of trust in science, developed by a health communications expert. The intervention will then be both pretested and pilot-tested to determine its viability. Study outcomes will include trust in science, a COVID-19 narrative belief latent profile membership, and the likelihood to engage in preventive behaviors, which will be controlled by 8 theoretically selected covariates. RESULTS This study was funded in August 2020, approved by the Indiana University Institutional Review Board on September 15, 2020, and prospectively registered with ClinicalTrials.gov. CONCLUSIONS COVID-19 misinformation prophylaxis is crucial. This proposed experiment investigates the impact of a brief yet actionable intervention that can be easily disseminated to increase individuals’ trust in science, with the intention of affecting misinformation believability and, consequently, preventive behavioral intentions. CLINICALTRIAL ClinicalTrials.gov NCT04557241; https://clinicaltrials.gov/ct2/show/NCT04557241 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/24383

scholarly journals A Scoping Review of the Examination of Sandwiched Caregivers’ Psychological Well-being and Physical Health

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 814-814
Author(s):  
Barbara Hodgdon ◽  
Jen D Wong ◽  
Patricia S Pittman
Keyword(s):  
United States ◽  
Depressive Symptoms ◽  
Health Behaviors ◽  
Physical Health ◽  
Scoping Review ◽  
Well Being ◽  
The United States ◽  
Psychological Well Being ◽  
Care Recipients ◽  
The Impact

Abstract As numbers of sandwiched caregivers in the United States grow, it is essential to document the literature on the impact of dual care responsibilities on aspects of psychological well-being and physical health. This scoping review examined the literature on sandwiched caregivers’ psychological well-being and physical health, identified gaps in the literature, and provided suggestions for future studies to advance the literature on sandwiched caregivers in the United States. Guided by the Arksey and O’Malley (2005) framework, this scoping review comprised of 15 peer-reviewed articles between 1980 and 2019, that examined aspects of the psychological well-being (e.g., depression, affect) and physical health (e.g., health behaviors, chronic conditions) of sandwiched caregivers in the United States. Findings showed that there was ambiguity surrounding the conceptualization of sandwiched caregivers, specifically how older and younger care recipients were defined. Also, most studies examined psychological well-being while physical health was understudied. The findings of this review also showed that, compared to non-sandwiched caregivers (e.g., spousal, filial caregivers) and non-caregivers, sandwiched caregivers exhibited greater depressive symptoms and psychological distress as well as poorer health behaviors. Furthermore, sandwiched caregivers who were female and employed were more susceptible to greater depressive symptoms than their employed male counterparts or employed non-caregivers. In considering future directions, more work is needed that examines physical health. Additionally, sandwiched caregivers of minority status merit attention as multigenerational care occurs at greater rates in these populations. Finally, caregiving during the pandemic may have a detrimental impact on sandwiched caregivers’ lives which should be investigated.

scholarly journals The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Andrew B. Ross ◽  
Vivek Kalia ◽  
Brian Y. Chan ◽  
Geng Li
Keyword(s):  
United States ◽  
Health Care ◽  
Emergency Department ◽  
Diagnostic Imaging ◽  
Race And Ethnicity ◽  
National Hospital ◽  
Patient Race ◽  
Care Survey ◽  
Race Ethnicity ◽  
Ambulatory Medical Care

Abstract Background An established body of literature has shown evidence of implicit bias in the health care system on the basis of patient race and ethnicity that contributes to well documented disparities in outcomes. However, little is known about the influence of patient race and ethnicity on the decision to order diagnostic radiology exams in the acute care setting. This study examines the role of patient race and ethnicity on the likelihood of diagnostic imaging exams being ordered during United States emergency department encounters. Methods Publicly available data from the National Hospital Ambulatory Medical Care Survey Emergency Department sample for the years 2006–2016 was compiled. The proportion of patient encounters where diagnostic imaging was ordered was tabulated by race/ethnicity, sub-divided by imaging modality. A multivariable logistic regression model was used to evaluate the influence of patient race/ethnicity on the ordering of diagnostic imaging controlling for other patient and hospital characteristics. Survey weighting variables were used to formulate national-level estimates. Results Using the weighted data, an average of 131,558,553 patient encounters were included each year for the 11-year study period. Imaging was used at 46% of all visits although this varied significantly by patient race and ethnicity with white patients receiving medical imaging at 49% of visits and non-white patients at 41% of visits (p < 0.001). This effect persisted in the controlled regression model and across all imaging modalities with the exception of ultrasound. Other factors with a significant influence on imaging use included patient age, gender, insurance status, number of co-morbidities, hospital setting (urban vs non-urban) and hospital region. There was no evidence to suggest that the disparate use of imaging by patient race and ethnicity changed over the 11-year study time period. Conclusion The likelihood that a diagnostic imaging exam will be ordered during United States emergency department encounters differs significantly by patient race and ethnicity even when controlling for other patient and hospital characteristics. Further work must be done to understand and mitigate what may represent systematic bias and ensure equitable use of health care resources.

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