A growing body of research shows a link between gender, race and ethnicity and unsafe patient care, but some experts say more comprehensive patient data are needed to better understand why certain groups are more likely to be harmed by medical error.
In an 2022 Health Affairs article that addressed U.S. trends and policy recommendations, the authors said “a major limitation” researchers face “is the lack of data sources that contain both patient safety and race/ethnicity information.” The researchers made three recommendations they said would go a long way toward allowing researchers to investigate the relationship between a patient’s race or ethnicity and trends in medical mistakes such as diagnosis errors and underdiagnosis.
Those recommendations were:
- Hospitals should collect race and ethnicity data in existing patient surveys.
- Patient safety organizations should ask hospitals for patient race and ethnicity data.
- More state governments should follow Pennsylvania’s lead and require that health care institutions collect race and ethnicity data in all incidents where patients were harmed or may have been harmed.
Some research has sought to determine whether income and education are linked to patient safety incidents. In a 2018 systematic review of studies in primary care settings in the U.S. and other high-income countries, the research suggested that socioeconomic factors influenced patient safety. One study from Denmark, a country renowned in the medical community for its innovative and effective patient safety practices, suggested that “female patients with a large household fortune experienced shorter system delays than economically less privileged female patients.”
Inge Kristensen, the CEO of the Danish Society for Patient Safety, said public health researchers in Denmark have a long way to go in studying disparities in its increasingly diverse population, which includes a significant number of immigrants from the Middle East. Health care providers, hospital administrators and others in the medical community are aware that those men, women and children don’t have the same access to care as their native-born peers. But long-held views that everyone in the country gets high-quality care stand in the way of change, Kristensen said.
“We think we are equal,” said Kristensen, who was one of the speakers at a conference in July organized by the Society to Improve Diagnosis in Medicine in Utrecht, Netherlands. The Society, like many other patient safety groups, has begun to recognize the urgent need for data on how and why patient safety varies by race, sex, income level, culture and other factors. Health equity will be the focus of the Society’s next global conference in Cleveland, Ohio, from Oct. 8 to 11.
Disparities data hints at equity issues in patient safety
For decades, research on health disparities by race and ethnicity has offered clues about inequity in care. Studies about social determinants of health have exposed that educational attainment, income, and insurance coverage influence access to care and quality of care.
One recent analysis by The Leapfrog Group, a nonprofit that advocates for patient safety and ranks hospitals around the country, suggested that more publicly available data could spur organizations to work on reducing disparities. It found that:
- Black Americans had significantly higher rates of harmful events in five safety indicators, when compared to their non-Hispanic white peers. Differences were most notable in surgery measures such as postoperative sepsis infection and respiratory failure.
- Medicare and Medicaid patients had much higher rates of adverse events in several general and postoperative measures when compared to people who had private insurance.
- In addition, the authors said: “Broadly, we find that disparities between privately and publicly ensured patient cohorts are large, significant, and fairly common across all hospitals irrespective of their Hospital Safety Grade.”
Leapfrog said Black and Hispanic patients and patients with public insurance “would benefit from better tools to help them assess the additional risk that may accompany a hospital stay.” It added: “A public-facing Hospital Safety Grade by patient racial and ethnic group may incentivize hospitals to narrow existing disparities.”
Another area of focus is giving health care providers tools to incorporate more patient input in care. For example, the Society’s upcoming conference in Ohio will feature a session covering strategies for “meaningful patient engagement specifically with marginalized patients.”
Effective communication is a key part of that, according to Mary Dahm, Ph.D., a senior research fellow at the Institute of Communication in Health Care at the University of Australia, who talked at the Utrecht meeting about the influence clinician-patient communication has in diagnostic errors. Stereotypes held by clinicians may affect the way they talk and listen to their patients, and even how they talk about patients to their colleagues — all of which affects the quality of care the patient gets, Dahm said.
Dahm, a linguist who studies how language influences the diagnostic process, said clinicians spend years taking in medical terminology from textbooks and journal articles, and “they get to a point where they can’t really tell anymore that what they’re using is actually a term that is not transparent to the other person.”
Mary Chris Jaklevic, AHCJ’s health beat leader for patient safety, contributed to this post. She has been a contributor to HealthNewsReview.org, a project that aimed to improve health care journalism by critiquing the accuracy and balance of media messages about medical interventions, and was an AHCJ board member from 2005 to 2009.
Birnbaum’s and Jaklevic’s attendance at the Society to Improve Diagnosis in Medicine conference in Utrecht, Netherlands, was made possible by the Gordon and Betty Moore Foundation.