Measuring Health Equity in Emergency Care Using Routinely Collected Data: A Systematic Review

Abstract

Introduction: Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care. Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socioeconomic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PubMed, and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care-sensitive condition-related ED visits were the two most frequently used equity indicators. The studies analyzed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy, and financial and nonfinancial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care. Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded measurement of health care equity than using any one indicator in isolation. Although studies analyzed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.

Variations in Emergency Service Utilization among Cancer Survivors: Results from the Pan-Canadian Experiences of Cancer Patients in Transition Study Survey

“…Another important factor to consider when using quality metrics to guide quality improvement is how using different measures for the same concept can reflect different aspects of healthcare quality. For example, a recent review identified 14 unique ESU measures from 29 studies [ 39 ]. The authors concluded that the number or frequency of use of emergency services was believed to measure accessibility, whereas the time between arrival to the emergency department and diagnosis or treatment was believed to measure timeliness [ 39 ].…”

“…For example, a recent review identified 14 unique ESU measures from 29 studies [ 39 ]. The authors concluded that the number or frequency of use of emergency services was believed to measure accessibility, whereas the time between arrival to the emergency department and diagnosis or treatment was believed to measure timeliness [ 39 ]. A review of cancer survivors' healthcare utilization patterns identified that it was not just the number of healthcare visits that were associated with the quality of healthcare but also the type of provider and the number of patients shared between providers [ 16 ].…”

“…A review of cancer survivors' healthcare utilization patterns identified that it was not just the number of healthcare visits that were associated with the quality of healthcare but also the type of provider and the number of patients shared between providers [ 16 ]. In our study, we used the number of times emergency services were used over a 12-month period, which is hypothesized to reflect differential access to inpatient, acute care versus outpatient, and routine care [ 39 ]. It is important that future research should aim to understand the dimensions of healthcare quality reflected by ESU among cancer survivors across different contexts to be able to make meaningful changes with these results.…”

Applying an equity lens to hospital safety monitoring: a critical interpretive synthesis protocol

“…In addition to the problems with hospital safety monitoring systems already noted in the literature, recent research is showing that they may not capture critical details about equity (eg, race/ethnicity, religion, sex, gender, income, financial barriers, disability21 26–28) that would make explicit the ways that equity-related factors influence safety practices and events. For instance, studies have reported race differences in adverse event occurrence by type and hospital setting6 and that voluntary incident reporting systems may underdetect safety issues in marginalised populations 5.…”

Developing and Validating an Individual-Level Deprivation Index for Children’s Health in France

“…Overtime, for moderately deprived patients, several interventions may also be needed. Studying the appropriateness of health care pathways is a new challenge to fit health services with the patient resources and needs [58,59].…”