Evidence of Inequity in Patient Care

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Articles

Patient Perceptions of Behavioral Flags in the Emergency Department: A Qualitative Analysis This study aims to investigate patient perceptions and perceived benefits and harms associated with the use of behavioral flags.
Systematic Review, Quality Assessment, and Synthesis of Guidelines for Emergency Department Care of Transgender and Gender-diverse People: Recommendations for Immediate Action to Improve Care We conducted this systematic review to identify emergency department (ED) relevant recommendations in current guidelines for care of transgender and gender-diverse (TGD)people internationally.
Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races.
Racial Differences in Triage for Emergency Department Patients with Subjective Chief Complaints Black and Hispanic patients are frequently assigned lower acuity triage scores than White patients. This can lead to longer wait times, less aggressive care, and worse outcomes. In this study we aimed to determine whether these effects are more pronounced for patients with subjective complaints.
Addressing Emergency Department Care for Patients Experiencing Incarceration: A Narrative Review Patients experiencing incarceration face a multitude of healthcare disparities. These patients are disproportionately affected by a variety of chronic medical conditions.
A Call to Improve Medical Education on Skin of Color Education on such matters should begin in medical school, as physicians of all specialties would benefit from learning how diseases can present differently in patients of color.
Editorial: A closer examination of the racial discrepancies in ED cardiac care The undercurrent of racial disparities in health care is undeniable and remains pervasive despite concerted efforts to mitigate disparities in outcomes. This is well documented in a number of areas including access to care and pain management as well as the evaluation and management of chest pain.
Race differences in cardiac testing rates for patients with chest pain in a multisite cohort Identifying and eliminating racial health care disparities is a public health priority. However, data evaluating race differences in emergency department (ED) chest pain care are limited.
Covid-19 Booster Vaccine Hesitancy in the Emergency Department Little is known about COVID-19 booster vaccine hesitancy. We sought to determine the uptake of booster vaccines, as well as the prevalence of and reasons for booster hesitancy in emergency department (ED) patients.
Racial, Ethnic, and Socioeconomic Disparities in Out-of-Hospital Pain Management for Patients with Long Bone Fractures To evaluate racial and ethnic disparities in out-of-hospital analgesic administration, accounting for the influence of clinical characteristics and community socioeconomic vulnerability, among a national cohort of patients with long bone fractures.
State Restrictions and Geographic Access to Gender-Affirming Care for Transgender Youth As of May 2023, a total of 20 states have enacted legislation, executive actions, or other policies restricting health care for transgender youths, with more than 100 bills under consideration.
The Supreme Court’s Rulings on Race Neutrality Threaten Progress in Medicine and Health In landmark rulings, the US Supreme Court significantly restricted race-conscious admissions policies in higher education, a chilling echo of its evisceration of settled law on abortion.
US Maternal Mortality Is Unacceptably High, Unequal, and Getting Worse—What Can Be Done About It? A report released this spring by the National Center for Health Statistics summarized the strikingly high rates of maternal deaths in the US. In 2021.
For Health Equity, We Must End Mass Incarceration Nearly 80 million individuals in the US have a criminal record and are living with the ongoing collateral consequences after conviction, including lifelong prohibitions on voting, food and housing assistance, and employment.
Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States Evidence suggests that maternal mortality has been increasing in the US. Comprehensive estimates do not exist. Long-term trends in maternal mortality ratios (MMRs) for all states by racial and ethnic groups were estimated.
A Chance to Modernize Health Care behind Bars — Section 1115 Medicaid Inmate Exclusion Waivers Waivers of the Medicaid Inmate Exclusion Policy could present an important opportunity to improve the conditions under which health care is delivered in jails and prisons in the United States.
Expanding Access to Health Care for DACA Recipients About one third of DACA recipients are uninsured. A proposed rule would allow recipients to participate in the Affordable Care Act’s health insurance exchanges.
Pursuing Gender Equity by Paying for What Matters in Primary Care Gender-based pay disparities underscore the need to design a payment system that adequately compensates physicians for the thoughtful, relationship-based care that defines excellent primary care.
From inequity to access: Evidence-based institutional practices to enhance care for individuals with disabilities People with disabilities experience barriers to care in all facets of health care, from engaging with the provider in a clinical setting (attitudinal and communication barriers) to navigating a large institution in a complex health care environment (organizational and environmental barriers), culminating in significant health care disparities.
Hot off the press: Microaggressions in the emergency department Patient experiences of care are associated with health outcomes and may impact perspectives of emergency department (ED) care and the patient recovery process.1
Addressing Racialized Aging in Medicine By 2030, 1 in 5 Americans will be over 65 years old, demanding specialized care. The American Geriatric Society estimates that 30% of this population would benefit from geriatric specialty care, requiring a fivefold increase in geriatricians by 2030.
Disparities in use of physical restraints at an urban, minority-serving hospital emergency department Recent reports have identified associations between patient race and ethnicity and use of physical restraint while receiving care in the emergency department (ED). However, no study has assessed this relationship in hospitals primarily treating patients of color and underserved populations.
Analysis of bias in toxicology screening of patients in serious motor vehicle collisions In 2010, the State of Massachusetts enacted a provision to the Safe Driving Law, allowing physician reporting of patients to the Registry of Motor Vehicles (RMV) for “reasonable cause to believe that an operator is not physically or medically capable of safely operating a motor vehicle
Gender moderates the association between post traumatic stress disorder and mutual intimate partner violence in an emergency department sample Patients in emergency departments (EDs) constitute a diverse population with multiple health-related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines the interaction effect of depression, posttraumatic stress disorder (PTSD), impulsivity, drug use, adverse childhood experiences (ACEs), at-risk drinking, and having a hazardous drinker partner with gender on mutual physical IPV in an urban ED sample
Patient perceptions of microaggressions and discrimination toward patients during emergency department care Disparities in emergency department (ED) care based on race and ethnicity have been demonstrated. Patient perceptions of emergency care can have broad impacts, including poor health outcomes.
Delayed first medical contact to reperfusion time increases mortality in rural emergency medical services patients with ST-elevation myocardial infarction ST-elevation myocardial infarction (STEMI) guidelines recommend an emergency medical services (EMS) first medical contact (FMC) to percutaneous coronary intervention (PCI) time of ≤90 min. The primary objective of this study was to evaluate the association between FMC to PCI time and mortality in rural STEMI patients.
Eliminating pain disparities for children in the emergency department It is well established that racial and ethnic minoritized populations are more likely to experience health care disparities that are rooted in social injustice.1 Health care disparities are differences in access to, quality of, and outcomes from health care services that lead to worse health across population groups whose socioeconomic status, demographic characteristics, or identities are devalued (e.g., people of lower social class, ethnic/racial minorities).
Association of limited English proficiency with emergency department irregular departures and return visits: A cross-sectional cohort study in the Upper Midwest between January 2018 and December 2021 Patients with limited English proficiency (LEP) have been shown to experience disparities in emergency department (ED) care. The objectives of this study were to examine the associations between LEP and irregular ED departures and return ED visits.
Sex differences in guideline-consistent diagnostic testing for acute pulmonary embolism among adult emergency department patients aged 18–49 Pulmonary embolism (PE) is a frequent diagnostic consideration in emergency department (ED) patients, yet diagnosis is challenging because symptoms of PE are nonspecific. Guidelines recommend the use of clinical decision tools to increase efficiency and avoid harms from overtesting, including D-dimer screening in patients not at high risk for PE.
Association between neighborhood socioeconomic status and mechanical thrombectomy for acute ischemic stroke: A nationwide multilevel observational studyAcute ischemic stroke is a major health burden worldwide and mechanical thrombectomy is the treatment of choice for large-vessel occlusion stroke. This study aimed to evaluate the association between neighborhood socioeconomic status (SES) and the likelihood of receiving mechanical thrombectomy in patients with acute ischemic stroke.
Primary care and emergency department utilization patterns: Differences between White and Black low-acuity patients Emergency room utilization has continued to rise in the United States, increasing by 19.6% from 2006 to 2018. This trend poses a threat to patient safety and quality of care as high patient volumes and prolonged wait times can lead to delayed diagnosis and treatment.
Disparities in ED Opioid Prescribing Racial and ethnic minorities receive opioid prescriptions at lower rates and dosages than White patients. Though opioid stewardship interventions can improve or exacerbate these disparities, there is little evidence about these effects.
Executive Summary 2022 Consensus Conf Addressing Racism in EM thru Research Racism has not only contributed to disparities in health care outcomes, but also has negatively impacted the recruitment, retention, and promotion of historically excluded groups in academic medicine.
2022 Consensus Conf on DEI - EM Research Agenda for Addressing Racism thru Research Racism in emergency medicine (EM) health care research is pervasive but often under-recognized. To understand the current state of research on racism in EM health care research, we developed a consensus working group on this topic, which concluded a year of work with a consensus-building session as part of the overall Society for Academic Emergency Medicine (SAEM) consensus conference on diversity, equity, and inclusion: “Developing a Research Agenda for Addressing Racism in Emergency Medicine,” held on May 10, 2022.
Journal of the National Medical Association A peer-reviewed publication whose purpose is to address medical care disparities of persons of African Americans and other minority groups.
Myths about physical racial differences were used to justify slavery — and are still believed by doctors today by Linda Villarosa.The excruciatingly painful medical experiments went on until his body was disfigured by a network of scars. John Brown, an enslaved man on a Baldwin County, Ga., plantation in the 1820s and ’30s, was lent to a physician, Dr. Thomas Hamilton, who was obsessed with proving that physiological differences between black and white people existed. Hamilton used Brown to try to determine how deep black skin went, believing it was thicker than white skin.
“Slave Life in Georgia: A Narrative of the Life, Sufferings, and Escape of John Brown, a Fugitive Slave, Now in England. ” by John Brown. My name is John Brown. How I came to take it, I will explain in due time. When in Slavery, I was called Fed. Why I was so named, I cannot tell. I never knew myself by any other name, nor always by that; for it is common for slaves to answer to any name, as it may suit the humor of the master. I do not know how old I am but think I may be any age between thirty-five and forty. I fancy I must be about thirty-seven or eight; as nearly as I can guess. I was raised on Betty Moore's estate, in Southampton County, Virginia, about three miles from Jerusalem Court house and the little Nottoway river.
Health Disparities in the Latino Population by William A. Vaga, Micheal A. Rodriguez, and Elisabeth Gruskin.In this review, the authors provide an approach to the study of health disparities in the US Latino population and evaluate the evidence, using mortality rates for discrete medical conditions and the total US population as a standard for comparison. They examine the demographic structure of the Latino population and how nativity, age, income, and education are related to observed patterns of health and mortality. A key issue discussed is how to interpret the superior mortality indices of Latino immigrants and the subsequent declining health status of later generations.

Books

A Book of Medical Discourses: In Two Parts by Dr. Rebecca Lee-Crumpler, first African American woman to earn an M.D. degree
Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington. The product of years of prodigious research into medical journals and experimental reports long undisturbed, Medical Apartheid reveals the hidden underbelly of scientific research and makes possible, for the first time, an understanding of the roots of the African American health deficit. At last, it provides the fullest possible context for comprehending the behavioral fallout that has caused black Americans to view researchers—and indeed the whole medical establishment—with such deep distrust.
"Slave Life in Georgia: A Narrative of the Life, Sufferings, and Escape of John Brown, a Fugitive Slave, Now in England.” autobiography of John Brown, published in 1855. My name is John Brown. How I came to take it, I will explain in due time. When in Slavery, I was called Fed. Why I was so named, I cannot tell. I never knew myself by any other name, nor always by that; for it is common for slaves to answer to any name, as it may suit the humour of the master. I do not know how old I am but think I may be any age between thirty-five and forty. I fancy I must be about thirty-seven or eight; as nearly as I can guess. I was raised on Betty Moore's estate, in Southampton County, Virginia, about three miles from Jerusalem Court house and the little Nottoway river.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care: Confronting Racial and Ethnic Disparities in Healthcare by Dr. Mona Hanna-Attisha. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities.
What the eyes don’t see by Mona Hanna- Attisha. WHAT THE EYES DON’T SEE is a powerful first-hand account of the Flint water crisis, the signature environmental disaster of our time, and a riveting narrative of personal advocacy. Here is the dramatic story of how Dr. Mona used science to prove Flint kids were exposed to lead, and how she courageously went public with her research and faced a brutal backlash. With persistence and single-minded sense of mission, she spoke truth to power. The book explores the horrific reality of how misguided austerity policies and callous bureaucratic indifference placed an entire city at risk.

Videos

APHA's Advancing Racial Equity series: Racism: The Ultimate Underlying ConditionThis kick-off webinar of APHA's Advancing Racial Equity series examined racism and its historic and present-day impact on health and well-being.
APA: Racism and Black Mental Health . 1 AMA CME Free. This learning module prepares contemporary psychiatrists to practice with an anti-racism framework in the care of all patients, and especially African Americans. Competency in this area is provided through exploration of historical facts underscoring the linkage of "race" and material disadvantage in America, as well as the spread of scientific racism during nascent periods of psychiatry. Contemporary issues affecting African-American patients at the point of mental health care are emphasized, along with discussion of effective interventions for addressing the institutional, interpersonal, and internal manifestations of racism.

Podcasts

“The Health Disparities Podcast” by Movement is LifeTM is a multi-disciplinary coalition. Is a series of conversations about health disparities with people and organizations who are working to eliminate them
The Praxis This podcast aims to directly address and explore the effects of racism and other forms of marginalization so that we can collectively achieve health justice. We will journey through history, theory, science & medicine by embracing storytelling, interviews, and community expertise.
1619, Episode 4: How the Bad Blood Started Black Americans were denied access to doctors and hospitals for decades. From the shadows of this exclusion, they pushed to create the nation’s first federal health care programs.

Websites

Disparities by Indian Health Service
Institute for Healthcare Improvement: TA 102 Improving Health Equity , The 1.5-hour CME Course
Office of Minority Health Knowledge Center host books, journal articles and media related to the health status of racial and ethnic minority populations in the United States.
Latino Health Disparities by League of United Latin American Citizens (LULAC)
LGBTQ and Two Spirit people Health Resources by Indian Health Service
Racial Equity Institute resources to proactively understand and address racism in an organization and in the community where the organization is working
Brown Skin Matters - database of dermatological conditions on non-white skin for open use
Black & Brown Skin - Mind the Gap

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