Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The Institute of Medicine's landmark report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," documents the pervasiveness of racial and ethnic disparities in the U. S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. ⋯ Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.
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Disparities are likely to present both in the emergency department and within the larger health care system; however, disparities must be recognized to be addressed. This article summarizes the proceedings from the AEM Consensus Conference 2003: Disparities in Emergency Health Care. ⋯ Participants were asked to describe the means of defining, assessing, measuring, and investigating disparities that may occur in emergency care. The committee members who wrote this report were asked to examine the influence of health care systems and administration on disparities in health care, using the following series of questions to frame the discussion. 1) Are all disparities bad? 2) Are only the vulnerable served inadequately by our current health care system? 3) Are what appear to be inequities really systems incompetence? 4) We assume there should be no inequality in health care: does society also assume this? 5) What would be the systems costs of equality in health care?
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To determine if differences exist in hospital and intensive care unit (ICU)/operating room admission rates based on health insurance status. ⋯ Whereas there was no difference in admission rates to the ICU/operating room by insurance status, this single-center study does suggest an association between insurance status and admission to a general hospital service, which may or may not be causally related. Factors other than provider bias may be responsible for this observed difference.
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To determine if there are any differences in proportion of high-acuity care and low-acuity care provided to uninsured, Medicaid-insured, and privately insured emergency department (ED) patients. ⋯ Whereas there were some statistically discerned differences between insurance groupings for proportionate receipt of low-acuity care and high-acuity care among both the pediatric and adult populations, the magnitude of most differences noted was not large, and may not reflect important differences in health care need or ED use based on insurance.
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Regulatory bodies and institutional review boards are increasingly considering human subjects who are vulnerable to research not because of their intrinsic characteristics, but because of the particular situations or circumstances that they bring with them as potential research participants. Several subsets of emergency department patients may be considered vulnerable in the research setting. ⋯ These issues should be carefully considered when including such patients in research protocols. Special efforts should be made to ensure voluntary participation and understanding of the purposes and risks of participation.