bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Care Disparities in Emergency Medicine
Authors: Cone David C. , Richardson Lynne D. , Todd Knox H. , Betancourt Joseph R. , Lowe Robert A. 
Published: November 2003

AbstractThe Institute of Medicine's landmark report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” documents the pervasiveness of racial and ethnic disparities in the U.S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. The IOM authors describe two strategies that can reduce disparities in EM. First, workforce diversity is likely to result in a community of emergency physicians who are better prepared to understand, learn from, and collaborate with persons from other racial, ethnic, and cultural backgrounds, whether these be patients, fellow clinicians, or the larger medical and scientific community. Given the ethical and practical advantages of a more diverse EM workforce, continued and expanded initiatives to increase diversity within EM should be undertaken. Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.
Racial and Ethnic Disparities in the Clinical Practice of Emergency Medicine
Authors: Richardson Lynne D. , Babcock Irvin Charlene , Tamayo‐Sarver Joshua H. 
Published: November 2003

AbstractThere is convincing evidence that racial and ethnic disparities exist in the provision of health care, including the provision of emergency care; and that stereotyping, biases, and uncertainty on the part of health care providers all contribute to unequal treatment. Situations, such as the emergency department (ED), that are characterized by time pressure, incomplete information, and high demands on attention and cognitive resources increase the likelihood that stereotypes and bias will affect diagnostic and treatment decisions. It is likely that there are many as‐yet‐undocumented disparities in clinical emergency practice. Racial and ethnic disparities may arise in decisions made by out‐of‐hospital personnel regarding ambulance destination, triage assessments made by nursing personnel, diagnostic testing ordered by physicians or physician‐extenders, and in disposition decisions. The potential for disparate treatment includes the timing and intensity of ED therapy as well as patterns of referral, prescription choices, and priority for hospital admission and bed assignment. At a national roundtable discussion, strategies suggested to address these disparities included: increased use of evidence‐based clinical guidelines; use of continuous quality improvement methods to document individual and institutional disparities in performance; zero tolerance for stereotypical remarks in the workplace; cultural competence training for emergency providers; increased workforce diversity; and increased epidemiologic, clinical, and services research. Careful scrutiny of the clinical practice of emergency medicine and diligent implementation of strategies to prevent disparities will be required to eliminate the individual behaviors and systemic processes that result in the delivery of disparate care in EDs.
Emergency Medicine Education and Health Care Disparities
Authors: Hamilton Glenn , Marco Catherine A. 
Published: November 2003

AbstractEducation is the means by which learning occurs and, thereby, behavior is changed. One means of improving health care disparities is changing the behavior and understanding of key personnel in academic health centers. These individuals influence policy and procedure, design and evaluate health systems, and define curricular standards for graduate and undergraduate medical education. Emergency medicine provides many opportunities to educate at all levels, including faculty, residents, and students. In addition to our responsibilities in educating emergency medicine residents, the emergency department also provides an ideal learning environment for medical students and other health care providers. The broad issue of disparities in emergency health care may be approached from a variety of directions. The Consensus Group on Education chose to focus on cultural competency education at several levels as a means of tangibly changing its status for both the immediate and long terms.
Disparities in Emergency Department Health Care: Systems and Administration
Authors: O'Connor Robert E. , Haley Leon 
Published: November 2003

AbstractDisparities are likely to present both in the emergency department and within the larger health care system; however, disparities must be recognized to be addressed. This article summarizes the proceedings from the AEM Consensus Conference 2003: Disparities in Emergency Health Care. The goals of the conference were to examine the presence, causes, and outcomes related to disparities of health care as they occur in emergency departments, and determine the degree to which external forces have an impact on our patients. Participants were asked to describe the means of defining, assessing, measuring, and investigating disparities that may occur in emergency care. The committee members who wrote this report were asked to examine the influence of health care systems and administration on disparities in health care, using the following series of questions to frame the discussion. 1) Are all disparities bad? 2) Are only the vulnerable served inadequately by our current health care system? 3) Are what appear to be inequities really systems incompetence? 4) We assume there should be no inequality in health care: does society also assume this? 5) What would be the systems costs of equality in health care?
The Impact of Race on the Acute Management of Chest Pain
Authors: Venkat Arvind , Hoekstra James , Lindsell Christopher , Prall Dawn , Hollander Judd E. , Pollack Charles V. , Diercks Deborah , Kirk J. Douglas , Tiffany Brian , Peacock Frank , Storrow Alan B. , Gibler W. Brian 
Published: November 2003

Abstract Objectives: African Americans with acute coronary syndromes receive cardiac catheterization less frequently than whites. The objective was to determine if such disparities extend to acute evaluation and noninterventional treatment. Methods: Data on adults with chest pain (N= 7,935) presenting to eight emergency departments (EDs) were evaluated from the Internet Tracking Registry of Acute Coronary Syndromes. Groups were selected from final ED diagnosis: 1) acute myocardial infarction (AMI), n= 400; 2) unstable angina/non–ST‐elevation myocardial infarction (UA/NSTEMI), n= 1,153; and 3) nonacute coronary syndrome chest pain (non‐ACS CP), n= 6,382. American College of Cardiology/American Heart Association guidelines for AMI and UA/NSTEMI were used to evaluate racial disparities with logistic regression models. Odds ratios (ORs) were adjusted for age, gender, guideline publication, and insurance status. Non‐ACS CP patients were assessed by comparing electrocardiographic (ECG)/laboratory evaluation, medical treatment, admission rates, and invasive and noninvasive testing for coronary artery disease (CAD). Results: African Americans with UA/NSTEMI received glycoprotein IIb/IIIa receptor inhibitors less often than whites (OR, 0.41; 95% CI = 0.19 to 0.91). African Americans with non‐ACS CP underwent ECG/laboratory evaluation, medical treatment, and invasive and noninvasive testing for CAD less often than whites (p < 0.05). Other nonwhites with non‐ACS CP were admitted and received invasive testing for CAD less often than whites (p < 0.01). African Americans and other nonwhites with AMI underwent catheterization less frequently than whites (OR, 0.45; 95% CI = 0.29 to 0.71 and OR, 0.40; 95% CI = 0.17 to 0.92, respectively). A similar disparity in catheterization was noted in UA/NSTEMI therapy (OR, 0.53; 95% CI = 0.40 to 0.68 and OR, 0.68; 95% CI = 0.47 to 0.99). Conclusions: Racial disparities in acute chest pain management extend beyond cardiac catheterization. Poor compliance with recommended treatments for ACS may be an explanation.
Ethnic and Racial Disparities in Emergency Department Care for Mild Traumatic Brain Injury
Authors: Bazarian Jeffrey J. , Pope Charlene , McClung Jason , Cheng Yen Ting , Flesher William 
Published: November 2003

Abstract Objectives: To identify racial, ethnic, and gender disparities in the emergency department (ED) care for mild traumatic brain injury (mTBI). Methods: A secondary analysis of ED visits in the National Hospital Ambulatory Medical Care Survey for the years 1998 through 2000 was performed. Cases of mTBI were identified using ICD‐9 codes 800.0, 800.5, 850.9, 801.5, 803.0, 803.5, 804.0, 804.5, 850.0, 850.1, 850.5, 850.9, 854.0, and 959.01. ED care variables related to imaging, procedures, treatments, and disposition were analyzed along racial, ethnic, and gender categories. The relationship between race, ethnicity, and selected ED care variables was analyzed using multivariate logistic regression with control for associated injuries, geographic region, and insurance type. Results: The incidence of mTBI was highest among men (590/100,000), Native Americans/Alaska Natives (1026.2/100,000), and non‐Hispanics (391.1/100,000). After controlling for important confounders, Hispanics were more likely than non‐Hispanics to receive a nasogastric tube (OR, 6.36; 95% CI = 1.2 to 33.6); nonwhites were more likely to receive ED care by a resident (OR, 3.09; 95% CI = 1.9 to 5.0) and less likely to be sent back to the referring physician after ED discharge (OR, 0.47; 95% CI = 0.3 to 0.9). Men and women received equivalent ED care. Conclusions: There are significant racial and ethnic but not gender disparities in ED care for mTBI. The causes of these disparities and the relationship between these disparities and post‐mTBI outcome need to be examined.
Racial and Ethnic Disparities in Pediatric Appendicitis Rupture Rate
Authors: Guagliardo Mark F. , Teach Stephen J. , Huang Zhihuan J. , Chamberlain James M. , Joseph Jill G. 
Published: November 2003

Abstract Objectives: To determine if there are racial/ethnic differences in the rates of appendiceal rupture among the children of two large states. Because rupture is primarily due to delayed diagnosis, differences would suggest disparities in timely access to quality emergency care. Methods: This was an observational, cross‐sectional analysis of full‐year samples of acute appendicitis cases from California and New York children 4 to 18 years old. Racial/ethnic groups were compared for risk of appendiceal rupture adjusted for biological factors both before and after adjustment for the following socioeconomic, hospital, and admission characteristics: income, insurance, hospital type, and admission source. Results were interpreted in light of census data on the proportion of immigrants in each racial/ethnic group. Results: Compared with white children with acute appendicitis, Hispanic and Asian children have higher odds of rupture in California, whereas Asian and black/African American children have higher odds in New York. These differences roughly parallel the within‐state proportion of immigrant children in these groups. Adjustments for family, socioeconomic, and hospital characteristics attenuate but do not eliminate disparities. Conclusions: The authors found evidence of significant racial/ethnic disparities in rate of appendiceal rupture, an important and preventable outcome, in two large but dissimilar states. Immigrant groups may be most at risk for delayed emergency care. Future research should focus on immigration and acculturation as risk factors for appendicitis rupture in children.
Is Outpatient Care Associated with Lower Use of Inpatient and Emergency Care? An Analysis of Persons with HIV Disease
Authors: Pezzin Liliana E. , Fleishman John A. 
Published: November 2003

Abstract Objectives: The authors use data from the AIDS Costs and Service Utilization Survey (ACSUS) to investigate the extent to which use of ambulatory medical care is associated with inpatient and emergency department use among HIV‐infected persons. Methods: Parameter estimates were derived from simultaneous, multiequation models. Results: Higher use of ambulatory medical services is not significantly associated with lower probability of inpatient admissions or emergency department (ED) visits. For the subgroup of patients who received an AIDS diagnosis during the study period, however, the number of ambulatory visits had significant negative effects on hospitalizations and ED use. Conclusions: Outpatient care may offset inpatient and ED services at particular points in the disease course.
Evaluation of Race and Ethnicity on Alcohol and Drug Testing of Adolescents Admitted with Trauma
Authors: Marcin James P. , Pretzlaff Robert K. , Whittaker Holly L. , Kon Alexander A. 
Published: November 2003

Abstract Objectives: To describe the incidence of alcohol and drug testing in adolescents admitted for traumatic injury and to analyze these results with reference to race, ethnicity, and gender differences. Methods: Data were collected on adolescents (aged 12 through 17 years) from the National Trauma Data Bank. Testing statuses for alcohol and drugs were the two primary outcome variables. The results of these tests were the secondary outcome variables. Additional casemix variables included: race, ethnicity, gender, age, Glasgow Coma Scale score, Injury Severity Score, day and time of arrival, and payment source. Hierarchical, multivariable logistic regression models were used to assess the relationship of race, ethnicity, and gender with the primary and secondary outcome variables. Results: Differences noted in the likelihood of alcohol and drug testing among the different racial, ethnic, and gender groups demonstrated an increased likelihood of Hispanic males and African American females to receive alcohol testing (odds ratio [OR]: 1.48; 95% CI = 1.06 to 2.06; and OR: 1.30; 95% CI = 1.01 to 1.67, respectively). Results of testing revealed that females of all races were less likely than males to test positive for alcohol and drugs. Drug and alcohol testing was more common during evenings, nights, and weekends, as well as in the presence of neurologic injury. Conclusions: Whereas small disparities in alcohol and drug testing were noted in some minority race‐based groupings, systematic racial bias is not evident in adolescent trauma patients.
Are There Disparities in Emergency Care for Uninsured, Medicaid, and Privately Insured Patients?
Authors: Irvin Charlene Babcock , Fox James M. , Smude Bradley 
Published: November 2003

Abstract Objectives: To determine if there are any differences in proportion of high‐acuity care and low‐acuity care provided to uninsured, Medicaid‐insured, and privately insured emergency department (ED) patients. Methods: This was a retrospective, observational study using physician level of service provided as a marker for acuity. The study used computerized billing data (2000–2001) from an urban, teaching, Level I trauma center with 75,000 visits per year. All uninsured and Medicaid patients (age groups: pediatric, <18 years; adult, 18–64 years) were compared by physician level of service billed to Blue Cross–Blue Shield (BCBS) patients and analyzed using chi‐square. Low‐acuity care was defined by CPT codes 99281 and 99282. High‐acuity care was defined by CPT codes 99285 and 99291. Results: There were 152,379 total ED visits, with 13.2% BCBS (5,273 pediatric, 14,951 adult), 29.6% Medicaid (20,578 pediatric, 24,511 adult), and 8.1% uninsured (1,879 pediatric, 10,405 adult) patients. The percent of pediatric BCBS, Medicaid, and uninsured patients receiving low‐acuity care was 30%, 35.7%, and 35.8% (p < 0.001), respectively; and for high‐acuity care, it was 7.8%, 6.1%, and 6.8% (p < 0.001), respectively. The proportion of adults within these groupings was 13.7%, 13.2%, and 17.9% (p < 0.001) for low‐acuity care, and 28.5%, 22.9%, and 16.7% (p < 0.001) for high‐acuity care, respectively. Conclusions: Whereas there were some statistically discerned differences between insurance groupings for proportionate receipt of low‐acuity care and high‐acuity care among both the pediatric and adult populations, the magnitude of most differences noted was not large, and may not reflect important differences in health care need or ED use based on insurance.
Association between Insurance Status and Admission Rate for Patients Evaluated in the Emergency Department
Authors: Ruger Jennifer Prah , Richter Christopher J. , Lewis Lawrence M. 
Published: November 2003

Abstract Objectives: To determine if differences exist in hospital and intensive care unit (ICU)/operating room admission rates based on health insurance status. Methods: This was a retrospective, cross‐sectional study of data from hospital clinical and financial records for all 2001 emergency department (ED) visits (80,209) to an academic urban hospital. Hospital admission and intensive care unit (ICU)/operating room admissions were analyzed, controlling for triage acuity, primary complaint, diagnosis, diagnosis‐related group (DRG) severity, and demographics. Multivariate logistic regression models identified factors associated with hospital admission for underinsured (self‐pay and Medicaid) compared with other insured (private health maintenance organization, preferred provider organization, worker's compensation, and Medicare) patients. Results: Compared with the other insured group, underinsured patients were less likely, overall, to be admitted to the hospital (odds ratio [OR], 0.82; 95% CI = 0.76 to 0.90), controlling for all other factors studied. Subgroup analysis of common complaints showed underinsured patients with a chief complaint of abdominal pain (OR, 0.67; 95% CI = 0.55 to 0.80) or headache (OR, 0.61; 95% CI = 0.39 to 0.95) had the lowest adjusted ORs for admission to the hospital, compared with other insured patients. Underinsured patients with DRG of “menstrual and other female reproductive system disorders” (OR, 0.17; 95% CI = 0.06 to 0.51) or “esophagitis, gastroenteritis, and miscellaneous digestive disorders” (OR, 0.55; 95% CI = 0.28 to 0.96) also were less likely to be admitted compared with the other insured group. No significant differences in ICU/operating room admission rates were found between insurance groups. Conclusions: Whereas there was no difference in admission rates to the ICU/operating room by insurance status, this single‐center study does suggest an association between insurance status and admission to a general hospital service, which may or may not be causally related. Factors other than provider bias may be responsible for this observed difference.
Racial and Ethnic Disparities in Health: An Emergency Medicine Perspective
Authors: Blanchard Janice C. , Haywood Yolanda C. , Scott Carol 
Published: November 2003

AbstractSignificant disparities exist in health care based on race. Even when controlling for socioeconomic factors, minorities still have lower rates of utilization for certain procedures, higher mortality rates, and differences in usual source of care. There are a multitude of causes for these disparities, including differences based on access to care, the patient–doctor relationship, and insurance status. This article addresses possible factors that account for persistent disparities in health based on race and suggests approaches to remedying these disparities. Although many studies have been done on this topic, further research is needed to examine factors specifically in the emergency department setting.
Ethics Seminars: Vulnerable Populations in Emergency Medicine Research
Authors: Quest Tammie , Marco Catherine A. 
Published: November 2003

AbstractRegulatory bodies and institutional review boards are increasingly considering human subjects who are vulnerable to research not because of their intrinsic characteristics, but because of the particular situations or circumstances that they bring with them as potential research participants. Several subsets of emergency department patients may be considered vulnerable in the research setting. This may include patients who are vulnerable because of a medical condition, a baseline limitation of intellectual function, a social setting, psychosocial stressors, or other factors. These issues should be carefully considered when including such patients in research protocols. Special efforts should be made to ensure voluntary participation and understanding of the purposes and risks of participation.
Monitoring in Multiagent Organizations*
Authors: Baldenius Tim , Melumad Nahum D. , Ziv Amir 
Published: November 2003

AbstractThis paper studies how to assign “monitors” to productive agents in order to generate signals about the agents' performance that are most useful from a contracting perspective. We show that if signals generated by the same monitor are negatively (positively) correlated, then the optimal monitoring assignment will be “focused” (“dispersed”). This holds because dispersed monitoring allows the firm to better utilize relative performance evaluation. On the other hand, if each monitor communicates only an aggregated signal to the principal, then focused monitoring is always optimal since aggregation undermines relative performance evaluation. We also study team‐based compensation and randomized monitoring assignments. In particular, we show that the firm can gain from randomizing the monitoring assignment, compared with the optimal linear deterministic contract. Furthermore, under randomization, the conditional expected utility for the agent is higher when the agent is not monitored compared with the case where the agent is monitored. That is, the chance of being monitored serves as a “stick” rather than a “carrot”.
The Effects of Industry Specialization on Auditors' Inherent Risk Assessments and Confidence Judgements*
Authors: TAYLOR MARK H. 
Published: November 2003

AbstractThis study experimentally examines how industry specialization affects auditors' inherent risk assessments and their confidence in those risk assessments. Two groups of participants ‐ experienced banking specialist auditors and equally experienced nonbanking auditors ‐ provided inherent risk assessments for a hypothetical banking client for two financial statement accounts. They assessed inherent risk for an industry‐specific account (loans receivable) and for a nonindustry‐specific account (property and equipment). The results indicate that nonbanking auditors assessed inherent risk significantly higher than industry specialists for all but the valuation assertion for the loans receivable account. However, the difference between the nonbanking auditors' and banking specialists' inherent risk assessments was not as great for the property and equipment account. Further, nonspecialists were less confident about the appropriateness of their inherent risk assessments compared with industry specialists. Potential implications for research and practice are discussed in light of the study's findings.