Explaining Ethnic Disparities in Patient Safety: A Qualitative Analysis

Suurmond, Jeanine; Uiters, Ellen; Bruijne, Martine C. de; Stronks, Karien; Essink‐Bot, Marie‐Louise

doi:10.2105/ajph.2009.167064

Cited by 38 publications

(53 citation statements)

References 27 publications

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“…A previous qualitative study showed that actual shortfalls in quality of care for ethnic minority patients do occur and may lead to excess LOS and higher readmission rates among minority patients. For instance, language barriers between physician and patient may incur a higher risk of extra bed days or readmission because of a delayed or wrong diagnosis 25 , 26 , 28 , 44 . However, an appropriate reaction to language barriers may lead to appropriate extra LOS if for instance rehabilitation takes longer because of this.…”

Section: Discussionmentioning

confidence: 99%

Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study

Bruijne

Rosse

Uiters

et al. 2013

European Journal of Public Health

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Background: Studies in the USA have shown ethnic inequalities in quality of hospital care, but in Europe, this has never been analysed. We explored variations in indicators of quality of hospital care by ethnicity in the Netherlands. Methods: We analysed unplanned readmissions and excess length of stay (LOS) across ethnic groups in a large population of hospitalized patients over an 11-year period by linking information from the national hospital discharge register, the Dutch population register and socio-economic data. Data were analysed with stepwise logistic regression. Results: Ethnic differences were most pronounced in older patients: all non-Western ethnic groups > 45 years had an increased risk for excess LOS compared with ethnic Dutch patients, with odds ratios (ORs) (adjusted for case mix) varying from 1.05 [95% confidence intervals (95% CI) 1.02–1.08] for other non-Western patients to 1.14 (95% CI 1.07–1.22) for Moroccan patients. The risk for unplanned readmission in patients >45 years was increased for Turkish (OR 1.24, 95% CI 1.18–1.30) and Surinamese patients (OR 1.11, 95% CI 1.07–1.16). These differences were explained partially, although not substantially, by differences in socio-economic status. Conclusion: We found significant ethnic variations in unplanned readmissions and excess LOS. These differences may be interpretable as shortcomings in the quality of hospital care delivered to ethnic minority patients, but exclusion of alternative explanations (such as differences in patient- and community-level factors, which are outside hospitals’ control) requires further research. To quantify potential ethnic inequities in hospital care in Europe, we need empirical prospective cohort studies with solid quality outcomes such as adverse event rates.

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Section: Discussionmentioning

confidence: 99%

Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study

Bruijne

Rosse

Uiters

et al. 2013

European Journal of Public Health

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“…In this regard, patients who face language barriers are less likely than others to receive the same standard of medical care; are less likely to access preventative medicine and have an increased risk of non‐adherence to medication. Similarly, some studies indicated that language differences between physician and patient were associated with a higher risk of serious incidents 15,16 . Along this line, access to interpreters becomes a key factor in addressing language barriers.…”

Section: Discussionmentioning

confidence: 99%

Barriers faced by migrants in accessing healthcare for viral hepatitis infection

Guirgis

Nusair

et al. 2012

Internal Medicine Journal

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“…Secondly, we conducted a qualitative interview study with care providers, to better understand the process underlying ethnic differences in patient safety [14]. Three patterns of interactions between professional and patient that can contribute to ethnic differences in patient safety were identified: inappropriate responses by health care providers to objective characteristics of immigrant patients, such as low Dutch proficiency; misunderstandings between patients and care providers due to differences in illness perceptions and expectations about health care; and inappropriate care because of providers’ prejudices against or stereotypical ideas about patients of non-Dutch ethnic origin.…”

Section: Introductionmentioning

confidence: 99%

“…2) Healthcare characteristics (such as a protocolled use of interpreters): we also relied upon Stronks et al [15] along with the CLAS standards to define healthcare characteristics [16]. 3) Patient-care provider interaction: we used the work of Suurmond et al [14]. …”

Section: Introductionmentioning

confidence: 99%

Design of a prospective cohort study to assess ethnic inequalities in patient safety in hospital care using mixed methods

Rosse

Bruijne

Wagner

et al. 2012

BMC Health Serv Res

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BackgroundWhile US studies show a higher risk of adverse events (AEs) for ethnic minorities in hospital care, in Europe ethnic inequalities in patient safety have never been analysed. Based on existing literature and exploratory research, our research group developed a conceptual model and empirical study to increase our understanding of the role ethnicity plays in patient safety. Our study is designed to (1) assess the risk of AEs for hospitalised patients of non-Western ethnic origin in comparison to ethnic Dutch patients; (2) analyse what patient-related determinants affect the risk of AEs; (3) explore the mechanisms of patient-provider interactions that may increase the risk of AEs; and (4) explore possible strategies to prevent inequalities in patient safety.MethodsWe are conducting a prospective mixed methods cohort study in four Dutch hospitals, which began in 2010 and is running until 2013. 2000 patients (1000 ethnic Dutch and 1000 of non-Western ethnic origin, ranging in age from 45-75 years) are included. Survey data are collected to capture patients’ explanatory variables (e.g., Dutch language proficiency, health literacy, socio-economic status (SES)-indicators, and religion) during hospital admission. After discharge, a two-stage medical record review using a standardized instrument is conducted by experienced reviewers to determine the incidence of AEs. Data will be analysed using multilevel multivariable logistic regression. Qualitative interviews with providers and patients will provide insight into the mechanisms of AEs and potential prevention strategies.ConclusionThis study uses a robust study plan to quantify the risk difference of AEs between ethnic minority and Dutch patients in hospital care. In addition we are developing an in-depth description of the mechanisms of excess risk for some groups compared to others, while identifying opportunities for more equitable distributions of patient safety for all.

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Explaining Ethnic Disparities in Patient Safety: A Qualitative Analysis

Abstract: Our findings suggest that organizational and health professional practices contribute to the higher risk of patient safety events. Descriptive epidemiological research is needed to explore the impact of the 3 patterns on patient safety.

Cited by 38 publications

References 27 publications

Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study

Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study

Barriers faced by migrants in accessing healthcare for viral hepatitis infection

Design of a prospective cohort study to assess ethnic inequalities in patient safety in hospital care using mixed methods

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