Advancing Diagnostic Equity Through Clinician Engagement, Community Partnerships, and Connected Care.
Advancing Diagnostic Equity Through Clinician Engagement, Community Partnerships, and Connected Care.
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DOI：
10.1007/s11606-022-07966-8
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发表时间：
2023-04
影响因子：
5.7
通讯作者：
Singh, Hardeep
中科院分区：
文献类型：
--
作者：
Giardina, Traber D.;Woodard, LeChauncy D.;Singh, Hardeep
在美国，与诊断过程特别相关的股权问题值得进一步探索。例如，黑人、西班牙裔和亚洲患者感染、住院和死于新冠肺炎的比率明显较高，但接受冠状病毒检测的可能性较低。1在心脏测试和程序、精神健康诊断、阑尾炎诊断以及在急诊室接受诊断成像方面，也有类似的差异。2解决与诊断相关的不平等特别具有挑战性，特别是考虑到基于系统的解决方案没有充分针对诊断错误。我们建议对诊断不平等的定义如下：在社会、经济、人口或地理上处于不利地位的人口群体中，诊断过程中存在可预防的、不必要的差异。每年约有1/20的美国成年人在门诊环境中经历诊断错误，3但这可能低估了边缘化患者的频率，他们面临着额外的偏见、歧视和结构性因素。4缺乏足够的数据来源和严谨、标准化的方法限制了诊断误差的测量，也没有准确的流行病学数据。但是，对于被边缘化的患者，患病率和导致诊断错误的因素甚至被进一步探讨不足--特别是在多种社会身份交叉的情况下(例如，厌世)。缓解战略没有得到很好的制定，但迫切需要。考虑到边缘化患者面临的障碍，有几个
USA, equity issues specifically related to the diagnostic process warrant additional exploration. For example, Black, Hispanic, and Asian patients experience significantly higher rates of infection, hospitalization, and death from COVID-19, yet are less likely to be tested for coronavirus. 1 Similar disparities have been documented with cardiac testing and procedures, mental health diagnoses, appendicitis diagnosis, and receipt of diagnostic imaging in the ED. 2 Diagnosis-related inequity is particularly challenging to address especially given that diagnostic errors have been inadequately targeted by systemsbased solutions.We recommend the following definition of diagnostic inequity: the presence of preventable unwarranted variations in diagnostic processes among population groups that are socially, economically, demographically, or geographically disadvantaged. About 1 in 20 US adults experience a diagnostic error in the outpatient setting annually, 3 but this likely underestimates frequencies for marginalized patients, who face additional biases, discrimination, and structural factors. 4 Diagnostic error measurement is limited by lack of adequate data sources and rigorous and standardized methods, and precise epidemiologic data are not available. But, for marginalized patients, prevalence and factors contributing to diagnostic errors are even further underexplored—particularly where multiple social identities intersect (eg, misogynoir). Mitigation strategies are not well developed but are urgently needed. Given the barriers marginalized patients face, several
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DOI：
10.1093/jamia/ocy182
发表时间：
2019-05-01
影响因子：
6.4
作者：
Liaw, Winston R.;Jetty, Anuradha;Bazemore, Andrew W.
通讯作者：
Bazemore, Andrew W.
影响因子：
5.4
作者：
Singh H;Meyer AN;Thomas EJ
通讯作者：
Thomas EJ
影响因子：
2.6
作者：
Cyril S;Smith BJ;Possamai-Inesedy A;Renzaho AM
通讯作者：
Renzaho AM
影响因子：
6
作者：
Ortega, Gezzer;Rodriguez, Jorge A.;Bates, David W.
通讯作者：
Bates, David W.
影响因子：
5.7
作者：
Gordon, Howard S.;Solanki, Pooja;Gopal, Ravi K.
通讯作者：
Gopal, Ravi K.