First Nations’ hospital readmission ending in death: a potential sentinel indicator of inequity?

Abstract

In this study, we focused on readmissions for Ambulatory Care Sensitive Conditions (ACSC) ending in death, to capture those admissions and readmissions that might have been prevented if responsive primary healthcare was accessible. We propose this as a sentinel indicator of equity. We conducted analyses of Manitoba-based 30-day hospital readmission rates for ACSC which resulted in death, using data from 1986-2016 adjusted for age, sex, and socio-economic status. Our findings show that, across Manitoba, overall rates of readmissions ending in death are slowly increasing, and increasing more dramatically among northern First Nations, larger First Nations not affiliated with Tribal Councils, and in the western region of the province. These regions have continuously been highlighted as disadvantaged in terms of access to care, suggesting that the time for action is overdue. Rising rates of readmissions for ACSC ending in death suggest that greater attention should be placed on access to responsive primary healthcare. These findings have broader implications for territorial healthcare systems which purchase acute care services from provinces south of them. As an indicator of quality, monitoring readmissions ending in death could provide territorial governments insights into the quality of care provided to their constituents by provincial authorities.

Indigenous Cultural Safety Trainings for Healthcare Professionals Working in Ontario, Canada: Context and Considerations for Healthcare Institutions

“… 1 - 7 The need to improve accessibility and opportunity for cultural safety training is of substantial importance, as Indigenous Peoples continue to face the harmful and lethal impacts of systemic racism embedded within the Canadian healthcare system. 8 , 9 Systemic racism is described in the literature as: systemic racism . .…”

How systemic racism results in poorer outcomes for First Nations, and what First Nations are doing about it: the example of kidney health

“…Across Canada, the disparities in FN kidney disease is understood as exacerbated by the interaction of remoteness, associated with infrastructure gaps, limited access to expertise, and low socio-economic status [11,SES,13], institutional racism and the lingering yet continued effects of colonization [4]. Still, studies that disaggregate analyses on a per community basis have consistently shown differences across remote communities [14][15][16][17][18][19], suggesting that remoteness is not a decisive factor, and needs to be unpacked to truly comprehend determinants of better renal health outcomes for FNs. This paper focuses on how structural barriers to care have and continue to perpetuate poorer outcomes among FN at risk of kidney diseases, and on what FN are implementing to address these barriers.…”