与电子行为警报相关的差异对于紧急情况部门的安全和暴力问题
Adrian D Haimovich1, R Andrew Taylor2, Erika Chang-Sing2
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Annals of emergency medicine
|June 3, 2023
概括
紧急部门的电子行为警报不成比例地标记了年轻,黑人,公共保险和男性患者,可能会加强偏见并影响护理. 这些警报可能会导致医疗保健提供中的系统不平等.
科学领域:
- 医疗信息学 医疗信息学
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 紧急部门 (ED) 的电子行为警报旨在标记有行为或暴力事件史的患者.
- 然而,这些警报可能会强化患者的负面看法,并引入对护理的偏见.
- 描述ED电子行为警报对于理解其影响至关重要.
研究的目的:
- 通过使用电子健康记录数据来描述紧急部门的电子行为警报.
- 确定与安全相关的电子行为警报部署相关的患者级风险因素.
主要方法:
- 在美国东北部的医疗保健系统中,对10个ED的成年患者进行了回顾性横截面研究 (2013-2022).
- 手动选和分类电子行为警报的安全问题.
- 混合效应回归分析,以确定部署警报的风险因素.
主要成果:
- 在2,932,870次ED访问中,0.2%有电子行为警报;其中88%与安全相关.
- 患有安全相关警报的患者年轻,更有可能是男性和黑人.
- 与安全相关的警报与更高的护理终止率有关,并与年轻年龄,男性性别,非西班牙裔黑人种族和公共保险有关.
结论:
- 年轻,非西班牙裔黑人,公共保险和男性患者面临接受ED电子行为警报的风险更高.
- 这些警报可能会不成比例地影响对边缘化人口的护理.
- 电子行为警报有可能导致结构性种族主义,并延续医疗保健中的系统性不平等.
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