Article 8

=Racial/ethnic disparities and patient safety.=

Flores G, Ngui E.

Pediatr Clin North Am. 2006 Dec;53(6):1197-215.

This article was an extensive literature review regarding racial/ethnic disparities and patient safety focusing on the pediatric population. Following a very specific Medline search, limited to only certain journals, 323 articles were found, only 9 of which discussed racial/ethnic issues. Several studies revealed an increase risk for adverse medical events such as birth trauma, post-operative infections, and other complications in minority populations. One study revealed that those requesting Spanish interpreters were at a two times increased odds of adverse medical events. Three of the articles reviewed found no racial/ethnic disparities after multivariate analyses. The authors found that many of the articles were lacking details regarding specific cultural components such as English proficiency and primary language spoken at home. Also, in several students, analyses in sub-groups based on age were not done. The authors also proposed a conceptual model for understanding racial/ethnic disparities in pediatric patient safety. This included 5 key components: 1) there is a higher prevalence of known risk factors for medical errors among racial/ethnic minorities, 2) medical errors of omission and deviations from optimal practice are frequent and particularly important for racial/ethnic minorities, 3) adverse medical event definitions often fail to include important minority patient views on what constitutes harm, 4) language barriers result in a higher risk for medical errors and adverse medical events, and 5) data collection systems for identifying and monitoring racial/ethnic disparities in patient safety are often insufficient or absent. The authors also provided 2 illustrative examples of racial/ethnic disparities and the effect on patient safety. It has been shown in several studies that pediatric minority patients with asthma have greater severity and frequency of attacks and more frequent ED visits. Conversely, they are significantly less likely to receive prescriptions for medications or nebulizer for home use after hospital discharge, to be prescribed β2-agnoists, and to be prescribed anti-inflammatory medications. The disparity between the treatment of white children and minority children for a commonly treated disease such as asthma is shocking. The authors also mentioned the relationship between patient safety and language barriers, showing that even the use of ad hoc interpreters such as family members, friends, or untrained bilingual staff can adversely affect medical treatment. These ad hoc interpreters are likely to misinterpret or omit up to half of all physicians’ questions, are more likely to commit errors with potential or actual clinical consequences, have a higher risk for to mentioning medication side effects, and ignore embarrassing issues when children are interpreters. The authors also note that children whose families request Spanish interpreters have more than double the odds of serious medical events compared with those not requesting an interpreter. This was shocking as we are taught that the use of an interpreter improves the physician-patient relationship, and thus medical care. The authors propose that three basic interventions could result in substantial improvements in pediatric patient safety: 1) all hospitals and health care institutions should collect data on patients’ and parents’ regarding cultural issues such as primary language, race/ethnicity, and English proficiency, 2) health care providers and staff must be culturally competent, and 3) bilingual health care providers or trained medical interpreters should be provided to all low-English proficiency patients and their families.

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