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We examine racial and ethnic differences in opioid prescribing and dosing for long bone fractures at emergency department (ED) discharge. Methods:We conducted an electronic health records-based cross-sectional study of adults with long bone fractures who presented to the ED across 22 sites from a health care delivery system (2016 to 2017). We examined differences in opioid prescribing at ED discharge and, among patients with a prescription, differences in opioid dosing (measured as morphine milligram equivalents) by race/ethnicity, using regression modeling with statistical adjustment for patient, fracture, and prescriber characteristics.Results: A total of 11,576 patients with long bone fractures were included in the study; 64.4% were non-Hispanic white; 16.4%, 7.3%, 5.8%, and 5.1%, respectively, were Hispanic, Asian, black, and of other or unknown race; and 65.6% received an opioid at discharge. After adjusting for other factors, rates of opioid prescribing were not different by race/ethnicity; however, among patients with an opioid prescription, total morphine milligram equivalent units prescribed were 4.3%, 6.0%, and 8.1% less for Hispanics, blacks, and Asians relative to non-Hispanic whites. Conclusion:Racial and ethnic minority groups with long bone fractures receive similar frequencies of opioid prescriptions at discharge, with a small potency difference. How this affects pain relief and why it happens is unclear. [Ann Emerg Med.

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Background There is increased recognition in clinical settings of the importance of documenting, understanding, and addressing patients’ social determinants of health (SDOH) to improve health and address health inequities. This study evaluated a pilot of a standardized SDOH screening questionnaire and workflow in an ambulatory clinic within a large integrated health network in Northern California. Methods The pilot screened for SDOH needs using an 11-question Epic-compatible paper questionnaire assessing eight SDOH and health behavior domains: financial resource, transportation, stress, depression, intimate partner violence, social connections, physical activity, and alcohol consumption. Eligible patients for the pilot receiving a Medicare wellness, adult annual, or new patient visits during a five-week period (February-March, 2020), and a comparison group from the same time period in 2019 were identified. Sociodemographic data (age, sex, race/ethnicity, and payment type), visit type, length of visit, and responses to SDOH questions were extracted from electronic health records, and a staff experience survey was administered. The evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results Two-hundred eighty-nine patients were eligible for SDOH screening. Responsiveness by domain ranged from 55 to 67%, except for depression. Half of patients had at least one identified social need, the most common being stress (33%), physical activity (22%), alcohol (12%), and social connections (6%). Physical activity needs were identified more in females (81% vs. 19% in males, p < .01) and at new patient/transfer visits (48% vs. 13% at Medicare wellness and 38% at adult wellness visits, p < .05). Average length of visit was 39.8 min, which was 1.7 min longer than that in 2019. Visit lengths were longer among patients 65+ (43.4 min) and patients having public insurance (43.6 min). Most staff agreed that collecting SDOH data was relevant and accepted the SDOH questionnaire and workflow but highlighted opportunities for improvement in training and connecting patients to resources. Conclusion Use of evidence-based SDOH screening questions and associated workflow was effective in gathering patient SDOH information and identifying social needs in an ambulatory setting. Future studies should use qualitative data to understand patient and staff experiences with collecting SDOH information in healthcare settings.

Purpose: The coronavirus pandemic has created the greatest public health crisis in a century, causing > 500,000 deaths in the United States alone. Minoritized and socioeconomically disadvantaged groups have borne a disproportionate burden of severe illness, hospitalization, and death from COVID-19. Recently developed FDAapproved vaccines have been shown to significantly reduce severe COVID-19-related outcomes. Vaccination campaigns have the potential to advance health equity by prioritizing allocation to those at highest risk while striving for herd immunity. Large integrated health systems have been faced with the daunting task of meeting the rapidly evolving needs of diverse patient populations for the provision of population-based testing, treatment, education, and now vaccine distribution. We have designed a COVID-19 vaccine equity index (CVEI) to guide health system vaccination strategy. Methods: We considered proportion unvaccinated within a health care system. We then used real-time readily available electronic health record (EHR) COVID-19 testing positivity and proportion hospitalized to measure burden of illness by race/ethnicity. We used conditional probability and statistical theory to measure equity for unvaccinated individuals and to derive an index to highlight these inequities for specific subgroups. Results: We present an illustrative hypothetical example using simulated data for which we calculated the CVEI for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic patients. In the example, non-Hispanic Black and Hispanic patients had inequitable outcomes. Conclusion:The index can be widely implemented to promote more equitable outcomes among racial/ethnic groups, reducing morbidity and mortality within the overall population as we pursue the collective goal of herd immunity through mass vaccination.

To measure COVID-19 disparities among racial/ethnically marginalized groups in hospitalization and ICU (Intensive Care Unit)-transfer pre/post implementation of the California statewide shelter-in-place (SIP) policy. A retrospective cohort study was conducted at a healthcare system in California. COVID-19 patients from 1/1/20-8/31/20 were identified from electronic health records. We examined hospitalizations and ICU transfers by race/ethnicity and pandemic period using logistic regression. Among 16,520 people with COVID-19 (mean [SD] age, 46.6 [18.4] years; 54.2% women); during the Post-SIP period, patients were on average younger and a larger proportion were Hispanic. In adjusted models, odds of hospitalization were 20% lower post-SIP compared to SIP, yet all non-White groups had higher odds (ORs 1.6-2.1) compared to Non-Hispanic White, regardless of period. Among hospitalized patients, odds of ICU transfer were 33% lower post-SIP versus SIP. Hispanic and Asian patients had higher odds compared to Non-Hispanic. Disparities in hospitalization persisted while ICU risk became more pronounced for Asian and Hispanic patients in post-SIP. Policy makers should consider ways to proactively address inequities in risk when considering future population-level policy interventions for public health crises.

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Objectives 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. We conducted a secondary analysis of a cluster‐randomized controlled trial conducted among 438 clinicians from 21 emergency departments and 27 urgent care clinics. Our objective was to determine whether randomly allocated opioid stewardship clinician feedback interventions that were designed to reduce opioid prescriptions had unintended effects on disparities in prescribing by patient race and ethnicity. Methods The primary outcome was likelihood of receiving a low‐pill prescription (low ≤10 pills, medium 11–19 pills, high ≥20 pills). Generalized mixed‐effects models were used to determine patient characteristics associated with low‐pill prescriptions during the baseline period. These models were then used to determine whether receipt of a low‐pill prescription varied by patient race or ethnicity during the intervention period between usual care and three opioid stewardship interventions: (1) individual audit feedback, (2) peer comparison feedback, and (3) combined (individual audit + peer comparison) feedback. Results Compared with White patients, Black patients were more likely to receive a low‐pill prescription during the baseline (adjusted odds ratio [OR] 1.18, 95% confidence interval [CI] 1.06–1.31, p = 0.002) and intervention (adjusted OR 1.43, 95% CI 1.07–1.91, p = 0.015). While combined feedback was associated with an overall increase in low‐pill prescriptions as intended (adjusted OR 1.89, 95% CI 1.28–2.78, p = 0.001), there were no significant differences in treatment effects of any of the interventions by patient race and ethnicity. Conclusions Combined individual audit and peer comparison feedback was associated with fewer opioid pills per prescription equally by patient race and ethnicity. However, the intervention did not significantly close the baseline disparity in prescribing by race.