Bias and Health Care Disparities
What are health care disparities?
A health care disparity is defined as unequal treatment or variations in the care quality we provide to populations with equal access to care, after taking into account clinical need and patient preferences.
What are Some Examples of the Evidence for Unequal Treatment?
To create a culture of health equity mindfulness in our clinical learning environment by:
In emergency room visits nationwide, racial/ethnic minorities were significantly less likely to receive adequate pain management as compared to whites for the exact same condition. Differential prescribing by race/ethnicity was evident for all types of pain visits to the emergency room and was more pronounced with increasing pain severity.1Trends in opioid prescribing by race/ethnicity for patients seeking care in us emergency departments.2The Interaction of Patient Race, Provider Bias, and Clinical Ambiguity on Pain Management Decisions.
Among patients with end-stage renal disease that want a renal transplant, black patients are significantly less likely than white patients to be referred to a renal transplant center and placed on a transplant waiting list, even after accounting for factors such as preference, insurance, and access.3The effect of patients’ preferences on racial differences in access to renal transplantation.4Racial disparities in access to renal transplantation–clinically appropriate or due to underuse or overuse?
Bias and Health Care Disparities
Why does unequal care occur, despite well-intentioned providers and a well-intentioned system?
These factors can be divided into two categories:
Institutional factors, which includes structural bias.
Structural bias refers to the ways that institutions have been designed to benefit one group over others. From a historical perspective, our health care systems have been designed by and led with one cultural perspective, and this singular perspective excludes individuals who do not identify with that culture or group.
Individual factors, which includes unconscious bias.
We each bring in our own biases, stereotypes, or assumptions to all interactions that we have that are based upon our own culture, background, or experiences and understanding. Unconscious bias can influence a health care provider’s assessments and decisions regarding a patient’s care, creating disparities in treatment. Bias and discrimination may also negatively impact provider-patient communication and lead to disparate outcomes and treatment.
What is it?
Your background, personal experiences, societal stereotypes, and cultural context can influence your decisions and actions without you realizing it. Unconscious bias happens when our brains make incredibly quick judgments and assessments of people and situations without us realizing.
Why is it important?
Unconscious bias is not about whether we are good or bad people. We all make assumptions. Our brains are wired to do so. Lack of awareness of our biases can lead us to treat people differently based on factors such as gender, skin color, or medical diagnosis, even if that is not our intent. This can impact patient care and hiring practices. This can also impact our selection of students or trainees into our academic programs.
Strategy to address unconscious bias:
P.A.U.S.E5From Howard Ross, Everyday Bias
Pay attention to what may be at play beneath any assessment.
Acknowledge your own reactions, interpretations, and judgments.
Understand that other reactions, interpretations, and judgments are possible.
Search for the most constructive, empowering way to deal with each encounter.
Execute an action/treatment plan guided by above.
What we are doing
The Value Imperative:
Goals to Reduce Health Care Disparities
Phase 2 – Epic changes
Measure and promote uptake
Add demographic filters to existing analytic platforms
Dashboards for key metrics of interest (e.g. Readmissions)
Develop infrastructure and process to routinely address identified disparities
What you can do
Consider your own unconscious biases and how they may impact the care you provide.
Examine data in your area to determine if there are disparities. Do you look at outcomes or quality metrics stratified by race or ethnicity?
Examine processes and structures within your organization to examine if they are inclusive of the breadth of your patient or employee population.