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Thursday, February 27, 2020
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ICU Outcomes are Improving in Many U.S. Hospitals — But Not Those Serving Mostly Minorities

Racial disparities in healthcare have long persisted, and new research shows that in certain settings, these differences may be getting worse.

Research published in the American Journal of Respiratory and Critical Care Medicine, found that ICU outcomes improved over a 10-year period in hospitals with few minority patients — but at hospitals with a more diverse population, progress was much slower.

What the study found

For the study, researchers from Beth Israel Deaconess Medical Center (BIDMC) looked at trends in ICU mortality and length of stay at more than 200 U.S. hospitals. They compared the data from 2006 to 2016 for two kinds of hospitals: those whose population was 25 percent or more African American or Latino (“minority serving”) and those with less than 25 percent African American or Latino patients (“non-minority”).

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Over the 10-year period, non-minority hospitals saw a steady, annual decline of 2 percent in its ICU mortality rate. During the same timeframe, minority-serving hospitals reported longer lengths of ICU stays and more critical illness hospitalizations than non-minority hospitals. 

The disparity was especially apparent among Black patients. “African Americans treated at non-minority hospitals experienced a 3 percent decline in mortality each year, compared to no decline in mortality when treated at minority-serving hospitals,” explained a press release.

The study abstract similarly noted: “While ICU and hospital lengths of stay decreased by 0.08 and 0.16 days per additional calendar year respectively, in non-minority serving hospitals, there was little temporal change for African Americans in minority-serving hospitals.”

Why the study matters

While the research establishes that differences in outcome based on race continue, it doesn’t explain why. It could stem from fewer resources and less-effective practices at minority-serving hospitals, or the systemic disadvantages that many minority patients and their communities face.

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Regardless, the research is important because “it identifies minority serving hospitals as an area of great need,” said lead author John Danziger, MD, MPhil, in a statement. “Focusing research efforts to further address these inequalities is critical in mitigating the disadvantages minorities face and ultimately closing the health care divide.”

What healthcare providers can do

At this stage, there isn’t adequate information available to tackle the issue from an organizational level. But as a provider, you should always endeavor to provide culturally sensitive care. Experts in this space recommend:

  • Asking questions about patients’ backgrounds to understand how they see themselves. Specifically, talk about ethnicity, culture and their preferred terms for each.
  • Practicing the “5 Rs of Cultural Humility.”
  • Integrating the social determinants of health into your daily tasks. Follow your facility’s SDoH screening process, or work with leaders to put one in place.
  • Advocating for documentation tools that use SDOH measures, especially in EHRs and standard assessments.
  • Making small talk with patients to gather a better understanding of their lifestyle and health.
  • Talking to your family and friends about racial and ethnic difference. It may feel uncomfortable, but it’s necessary to understand and respond to experiences different from your own.

References:

Temporal Trends in Critical Care Outcomes in United States Minority Serving Hospitals, American Journal of Respiratory and Critical Care Medicine.

Study: Critical Care Improvements May Differ Depending on Hospital’s Patient Population, Beth Israel Deaconess Medical Center.

5 Ways Healthcare Providers Can Minimize Racial Health Disparities, Florence Health.

You Know About the Importance of the Social Determinants of Health — Now What?, Florence Health.

Eliminate Implicit Bias From Patient Interactions by Practicing the ‘5Rs of Cultural Humility’, Florence Health.

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