Closing the gap: Perioperative health care disparities and patient safety interventions

Abstract

A main priority of today's health care system is addressing the contributions of systemic and structural factors to health care disparities. 1,2 Over several decades, research in health care disparities and health services has described how health care is organized, delivered, financed, and accessed and characterized how policies and interventions impact cost, quality, outcomes, and patient safety. Patient safety is founded on the principle that health care professionals are well intentioned but function within systems that can produce untoward effects for patients and populations. Patient safety, health, and health care disparities are inextricably linked. Therefore, exploring health care disparities in perioperative care, why they exist, and offering potential strategies to enhance equity is essential to improving patient safety. 3 Patient-centered care considers an individual's specific health needs and desired health outcomes and can serve as a path forward toward reducing disparate care. The way patients interact with clinicians and the health care system can significantly alter their perioperative trajectories. Anesthesiologists are uniquely involved in the entire spectrum of perioperative care, and patientcentered care remains a high priority in the management of pain and sequelae of anesthetic care.In this article, we will discuss evidence suggesting that racial and ethnic minorities receive differential anesthetic care relative to their white counterparts. Differential care is seen preoperatively during planning and medical optimization, intraoperatively in the choice of anesthetic technique, and postoperatively related to pain control and the management of unforeseen complications. We will then describe the individualclinician level (patient-centered) interventions and system-level (local, regional, and national) policies that can be implemented to reduce perioperative disparities.