Toward Improving Patient Equity in a Pediatric Emergency Department: A Framework for Implementation
Toward Improving Patient Equity in a Pediatric Emergency Department: A Framework for Implementation
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DOI：
10.1016/j.annemergmed.2022.11.015
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发表时间：
2023-03-20
影响因子：
6.2
通讯作者：
Akhter, Sabreen
中科院分区：
文献类型：
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作者：
Hartford, Emily A.;Thomas, Anita A.;Akhter, Sabreen
急诊科（ED）患者在种族、民族和护理语言（REaL）方面的卫生保健服务和健康结果差异是常见的，并且有充分的记录。解决结构性种族主义、隐性偏见和语言障碍造成的不平等问题可能具有挑战性，而且缺乏有效干预措施的数据。我们描述了在儿科急诊科实施多方面的公平改善战略，使用Kotter的变化模型作为框架来确定关键驱动因素。主要元素包括一个数据仪表板，其中的质量指标根据患者自我报告的REaL分层，以可视化差异，一个关于隐性偏见和微侵犯的员工研讨会，以及几个强调公平的临床和操作工具。我们接下来的步骤包括完善和重复干预措施，并跟踪重要的患者结果，包括及时的疼痛治疗、分诊评估、诊断评估和口译员的使用，随着时间的推移，我们的总体目标是通过REaL提高患者的公平性。本文提出了减少差距干预措施的路线图，这可以作为解决急诊科卫生公平问题的多方面方法的一部分。
Disparities in health care delivery and health outcomes for patients in the emergency department (ED) by race, ethnicity, and language for care (REaL) are common and well documented. Addressing inequities from structural racism, implicit bias, and language barriers can be challenging, and there is a lack of data on effective interventions. We describe the implementation of a multifaceted equity improvement strategy in a pediatric ED using Kotter's model for change as a framework to identify the key drivers. The main elements included a data dashboard with quality metrics stratified by patient self-reported REaL to visualize disparities, a staff workshop on implicit bias and microaggressions, and several clinical and operational tools that highlight equity. Our next steps include refining and repeating interventions and tracking important patient outcomes, including timely pain treatment, triage assessment, diagnostic evaluations, and interpreter use, with the overall goal of improving patient equity by REaL over time. This article presents a roadmap for a disparity reduction intervention, which can be part of a multifaceted approach to address health equity in EDs.