A Quality Framework to Address Racial and Ethnic Disparities in Emergency Department Care - 19/12/22

Doi : 10.1016/j.annemergmed.2022.08.010

Hazar Khidir, MD ^a,^b, Rama Salhi, MD, MHS ^c,^d, Amber K. Sabbatini, MD, MPH ^e,^f, Nicole M. Franks, MD ^g, Andrea Green, MD ^h, Lynne D. Richardson, MD ^i,^j, Aisha Terry, MD, MPH ^k,^l, Nicholas Vasquez, MD, MHSH ^m, Pawan Goyal, MD, MHA ⁿ, Keith Kocher, MD, MPH ^d, Arjun K. Venkatesh, MD, MBA ^a,^b,^o, Michelle P. Lin, MD, MPH ^p,^⁎
^a National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT
^b Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
^c National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
^d Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI
^e Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
^f Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
^g Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
^h University Medical Center Northeast, El Paso, TX
ⁱ Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY
^j Departments of Emergency Medicine and Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY
^k Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC
^l Department of Health Policy, Milken Institute of Public Health, George Washington University, Washington, DC
^m Envision Healthcare and Vitalyst Health Foundation, Phoenix, AZ
ⁿ American College of Emergency Physicians, Irving, TX
^o Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT
^p Department of Emergency Medicine at Stanford University School of Medicine, Palo Alto, CA

^∗Corresponding Author.

Abstract

The emergency department serves as a vital source of health care for residents in the United States, including as a safety net. However, patients from minoritized racial and ethnic groups have historically experienced disproportionate barriers to accessing health care services and lower quality of services than White patients. Quality measures and their application to quality improvement initiatives represent a critical opportunity to incentivize health care systems to advance health equity and reduce health disparities. Currently, there are no nationally recognized quality measures that track the quality of emergency care delivery by race and ethnicity and no published frameworks to guide the development and prioritization of quality measures to reduce health disparities in emergency care. To address these gaps, the American College of Emergency Physicians (ACEP) convened a working group of experts in quality measurement, health disparities, and health equity to develop guidance on establishing quality measures to address racial and ethnic disparities in the provision of emergency care. Based on iterative discussion over 3 working group meetings, we present a summary of existing emergency medicine quality measures that should be adapted to track racial and ethnic disparities, as well as a framework for developing new measures that focus on disparities in access to emergency care, care delivery, and transitions of care.

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	Supervising editor: Lois K. Lee, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Dr. Venkatesh reports support from the American Board of Emergency Medicine - National Academy of Medicine Fellowship, support from the Centers for Medicare and Medicaid Services for the development of hospital and health system quality measures and rating systems, and prior or current support from the National Institute of Drug Abuse, Moore Foundation, the Foundation for Opioid Response Efforts, Genentech Inc, and the American College of Emergency Physicians for the development of emergency care quality measures and work with the ACEP Clinical Emergency Data Registry. This publication was made possible by the Yale National Clinician Scholars Program and by Clinical and Translational Science Award (CTSA) Grant Number TL1 TR001864 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH) as well as the National Health Lung Blood Institute under award number K23 HL143042.
	The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Vol 81 - N° 1

P. 47-56 - janvier 2023 Retour au numéro

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A Quality Framework to Address Racial and Ethnic Disparities in Emergency Department Care - 19/12/22

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