Racial and Ethnic Disparities in the Emergency Department: A Public Health Perspective

Heron, Sheryl; Stettner, Edward; Haley, Leon L.

doi:10.1016/j.emc.2006.06.009

Cited by 52 publications

(41 citation statements)

References 50 publications

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“…The inability to afford medical care often translates to undiagnosed and poorly managed medical ailments (Halpern et al, 2008; Heron, Stettner, & Haley, 2006; Town, Wholey, Feldman, & Burns, 2007). We provided an opportunity for comprehensive medical examinations and clinical laboratory testing to those who otherwise could not afford such procedures.…”

Section: Resultsmentioning

confidence: 99%

Recruitment and Retention Strategies for Minority or Poor Clinical Research Participants: Lessons From the Healthy Aging in Neighborhoods of Diversity Across the Life Span Study

et al. 2011

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Purpose of the study: Investigating health disparities requires studies designed to recruit and retain racially and socioeconomically diverse cohorts. It is critical to address the barriers that disproportionately affect participation in clinical research by minorities and the socioeconomically disadvantaged. This study sought to identify and rectify these barriers to recruit and retain a biracial (African American and non-Hispanic White) and socioeconomically diverse cohort for a longitudinal study. Design and Method: The Healthy Aging in Neighborhoods of Diversity across the Life Span study is a 20-year longitudinal examination of how race and socioeconomic status influence the development of age-related health disparities. One goal was to create a multifactorial recruitment and retention strategy. The recruitment paradigm targeted known barriers and identified those unique to the study's urban environment. The retention paradigm mirrored the recruitment plan but was based on specifically developed approaches. Results: This cohort recruitment required attention to developing community partnerships, designing the research study to meet the study hypotheses and to provide benefit to participants, providing a safe community-based site for the research and creating didactics to develop staff cultural proficiency. These efforts facilitated study implementation and enhanced recruitment resulting in accrual of a biracial and socioeconomically diverse cohort of 3,722 participants. Implications: Recruiting and retaining minority or poor research participants is challenging but possible. The essential facets include clear communication of the research hypothesis, focus on providing a direct benefit for participants, and selection of a hypothesis that is directly relevant to the community studied

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Section: Resultsmentioning

confidence: 99%

Recruitment and Retention Strategies for Minority or Poor Clinical Research Participants: Lessons From the Healthy Aging in Neighborhoods of Diversity Across the Life Span Study

et al. 2011

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“…14,15 However, these studies may be affected by different biases, including spectrum bias, as under-represented minorities are more likely to identify the ED as their usual source of health care 16–19 and use the ED for nonurgent care. 20 Therefore, among other reasons, these differences may be more of a reflection of racial and ethnic differences in ED use rather than ED management, as minorities may be more likely to present to the ED for nonsurgical or less intense causes of abdominal pain.…”

mentioning

confidence: 99%

Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments

et al. 2015

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“…This creates a significant barrier to AMD documentation, as the medical social work team may not be able to see all the veterans before discharge, given their normal weekday working hours of 7:30 am to 4:30 pm. Additionally, it is possible that at the VA studied, a disproportionate number of African Americans are using the ED services, thus increasing the number of missed opportunities for addressing an AMD relative to Caucasians (Heron, Stettner, & Haley, 2006). This possibility requires additional examination.…”

Section: Discussionmentioning

confidence: 96%

Comparison of Advance Medical Directive Inquiry and Documentation for Hospital Inpatients in Three Medical Services: Implications for Policy Changes

Anunobi

Detweiler

Sethi

et al. 2015

Journal of Aging & Social Policy

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Following the introduction of the Patient Self-Determination Act of 1990, the Veterans Health Administration developed its own advance medical directive (AMD) policy, which most recently states that documentation is mandatory for all hospital patients in all settings. The object of this study was to assess the effectiveness of AMD documentation at a local Veterans Affairs Medical Center. AMD documentation was compared among three inpatient services: surgery, medicine, and psychiatry. Retrospective in nature, 594 inpatient cases were compared. Results revealed that, overall, the rate of AMD documentation was 37.7%. AMD documentation on surgery was statistically more frequent (45.6%) than for either medicine (33.2%) or psychiatry (34.5%). The difference between the numbers of days to AMD documentation for all three services was not statistically significant. While there was no statistically significant difference across gender, Caucasians had AMDs documented more frequently than African Americans (p < .001). Logistic regression reveals that social worker and physician intervention, not patient-specific variables, are the primary predictors of AMD incidence. Policy makers may need to consider the realities of hospital care, especially in emergency settings, and be more specific in the steps of implementation of the policy in the evenings, weekends, and holidays. True adherence to policy implementation may require hospital administrators to increase staff and educational efforts so that the concept of AMD communication and documentation is completely explained to all staff and patients. Policy should include an electronic record reminder that is renewed every 3 years and provisions for accommodating patients who arrive on weekends and holidays, with special awareness of the particular communication needs of minority groups. The study conclusions are that further inquiry is needed to understand these policy nuances to enable the Veterans Affairs Administration to improve its policies and performance in this important aspect of healthcare.

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Racial and Ethnic Disparities in the Emergency Department: A Public Health Perspective

Cited by 52 publications

References 50 publications

Recruitment and Retention Strategies for Minority or Poor Clinical Research Participants: Lessons From the Healthy Aging in Neighborhoods of Diversity Across the Life Span Study

Recruitment and Retention Strategies for Minority or Poor Clinical Research Participants: Lessons From the Healthy Aging in Neighborhoods of Diversity Across the Life Span Study

Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments

Comparison of Advance Medical Directive Inquiry and Documentation for Hospital Inpatients in Three Medical Services: Implications for Policy Changes

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