Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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There is convincing evidence that racial and ethnic disparities exist in the provision of health care, including the provision of emergency care; and that stereotyping, biases, and uncertainty on the part of health care providers all contribute to unequal treatment. Situations, such as the emergency department (ED), that are characterized by time pressure, incomplete information, and high demands on attention and cognitive resources increase the likelihood that stereotypes and bias will affect diagnostic and treatment decisions. It is likely that there are many as-yet-undocumented disparities in clinical emergency practice. ⋯ The potential for disparate treatment includes the timing and intensity of ED therapy as well as patterns of referral, prescription choices, and priority for hospital admission and bed assignment. At a national roundtable discussion, strategies suggested to address these disparities included: increased use of evidence-based clinical guidelines; use of continuous quality improvement methods to document individual and institutional disparities in performance; zero tolerance for stereotypical remarks in the workplace; cultural competence training for emergency providers; increased workforce diversity; and increased epidemiologic, clinical, and services research. Careful scrutiny of the clinical practice of emergency medicine and diligent implementation of strategies to prevent disparities will be required to eliminate the individual behaviors and systemic processes that result in the delivery of disparate care in EDs.
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This study sought to identify demographic, socioeconomic, and clinical predictors of aftercare noncompliance by pediatric emergency department (ED) patients. ⋯ Disparity in health insurance has been shown to be a predictor of poor aftercare compliance for pediatric ED patients within the patient population.
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To identify racial, ethnic, and gender disparities in the emergency department (ED) care for mild traumatic brain injury (mTBI). ⋯ There are significant racial and ethnic but not gender disparities in ED care for mTBI. The causes of these disparities and the relationship between these disparities and post-mTBI outcome need to be examined.
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Education is the means by which learning occurs and, thereby, behavior is changed. One means of improving health care disparities is changing the behavior and understanding of key personnel in academic health centers. These individuals influence policy and procedure, design and evaluate health systems, and define curricular standards for graduate and undergraduate medical education. ⋯ In addition to our responsibilities in educating emergency medicine residents, the emergency department also provides an ideal learning environment for medical students and other health care providers. The broad issue of disparities in emergency health care may be approached from a variety of directions. The Consensus Group on Education chose to focus on cultural competency education at several levels as a means of tangibly changing its status for both the immediate and long terms.
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The recent Institute of Medicine report "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" chronicles a growing body of literature describing racial and ethnic disparities in health care delivery. It suggests a research agenda designed to better understand and eventually eliminate these disparities. ⋯ One of the goals of that meeting was to develop a research agenda for emergency medicine researchers working on disparities in health care. This report describes the results of the consensus conference and suggests such a research agenda.