Heart Failure Admission Service Triage (H-FAST) Study: Racialized Differences in Perceived Patient Self-Advocacy as a Driver of Admission Inequities

Manchanda, Emily C. Cleveland; Marsh, Regan H.; Osuagwu, Chidinma; Michel, Jennifer Decopain; Dugas, Julianne; Wilson, Michael; Morse, Michelle; Lewis, Eldrin F.; Wispelwey, Bram

doi:10.7759/cureus.13381

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…A prior phase of our work evaluated the root causes for the disparities in initial admission triage of CHF patients 19 . In the study reported here, we aimed to use the Public Health Critical Race Praxis (PHCRP) framework to engage our QI teams, in collaboration with key stakeholders, in designing a QI initiative that addressed the barriers and needs of racial and ethnic subpopulations within an overall effort to improve outcomes for patients triaged to GMS.…”

Section: Introductionmentioning

confidence: 99%

A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine

et al. 2023

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Background Prior evaluation at our hospital demonstrated that, compared to White patients, Black and Latinx patients with congestive heart failure (CHF) were less likely to be admitted to the cardiology service rather than the general medicine service (GMS). Patients admitted to GMS (compared to cardiology) had inferior rates of cardiology follow-up and 30-day readmission. Objective To develop and test the feasibility and impacts of using quality improvement (QI) methods, in combination with the Public Health Critical Race Praxis (PHCRP) framework, to engage stakeholders in developing an intervention for ensuring guideline-concordant inpatient CHF care across all patient groups. Methods We compared measures for all patients admitted with CHF to GMS between September 2019 and March 2020 (intervention group) to CHF patients admitted to GMS in the previous year (pre-intervention group) and those admitted to cardiology during the pre-intervention and intervention periods (cardiology group). Our primary measures were 30-day readmissions and 14- and 30-day post-discharge cardiology follow-up. Results There were 79 patients admitted with CHF to GMS during the intervention period, all of whom received the intervention. There were similar rates of Black and Latinx patients across the three groups. Compared to pre-intervention, intervention patients had a significantly lower 30-day readmission rate (18.9% vs. 24.8%; p =0.024), though the cardiology group also had a decrease in 30-day readmissions from the pre-intervention to intervention period. Compared to pre-intervention, intervention patients had significantly higher 14-day and 30-day post-discharge follow-up visits scheduled with cardiology (36.7% vs. 24.8%, p =0.005; 55.7% vs. 42.3%, p =0.0029), but no improvement in appointment attendance. Conclusion This study provides a first test of applying the PHCRP framework within a stakeholder-engaged QI initiative for improving CHF care across races and ethnicities. Our study design cannot evaluate causation. However, the improvements in 30-day readmission, as well as in processes of care that may affect it, provide optimism that inclusion of a racism-conscious framework in QI initiatives is feasible and may enhance QI measures. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08086-7.

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Section: Introductionmentioning

confidence: 99%

A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine

et al. 2023

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Patients’ Perspectives on Race and the Use of Race-Based Algorithms in Clinical Decision-Making: a Qualitative Study

et al. 2023

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Background Clinical algorithms that incorporate race as a modifying factor to guide clinical decision-making have recently been criticized for propagating racial bias in medicine. Equations used to calculate lung or kidney function are examples of clinical algorithms that have different diagnostic parameters depending on an individual’s race. While these clinical measures have multiple implications for clinical care, patients’ awareness of and their perspectives on the application of such algorithms are unknown. Objective To examine patients’ perspectives on race and the use of race-based algorithms in clinical decision-making. Design Qualitative study using semi-structured interviews. Participants Twenty-three adult patients recruited at a safety-net hospital in Boston, MA. Approach Interviews were analyzed using thematic content analysis and modified grounded theory. Key Results Among the 23 study participants, 11 were women and 15 self-identified as Black or African American. Three categories of themes emerged: The first theme described definitions and the individual meanings participants ascribed to the term race. The second theme described perspectives on the role and consideration of race in clinical decision-making. Most study participants were unaware that race has been used as a modifying factor in clinical equations and rejected the incorporation of race in these equations. The third theme related to exposure to and experience of racism in healthcare settings. Experiences described by non-White participants ranged from microaggressions to overt acts of racism, including perceived racist encounters with healthcare providers. In addition, patients alluded to a deep mistrust in the healthcare system as a major barrier to equitable care. Conclusions Our findings suggest that most patients are unaware of how race has been used to make risk assessments and guide clinical care. Further research on patients’ perspectives is needed to inform the development of anti-racist policies and regulatory agendas as we move forward to combat systemic racism in medicine. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08035-4.

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The Impact of Health Care Disparities on Patients With Heart Failure

Morris¹,

Shah²,

Enciso³

et al. 2022

Journal of Cardiac Failure

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Heart Failure Admission Service Triage (H-FAST) Study: Racialized Differences in Perceived Patient Self-Advocacy as a Driver of Admission Inequities

Cited by 3 publications

References 15 publications

A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine

A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine

Patients’ Perspectives on Race and the Use of Race-Based Algorithms in Clinical Decision-Making: a Qualitative Study

The Impact of Health Care Disparities on Patients With Heart Failure

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