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Marchand T, Squires K, Daodu O, Brindle ME. Improving Indigenous health equity within the emergency department: a global review of interventions. CAN J EMERG MED 2024; 26:488-498. [PMID: 38683290 PMCID: PMC11230980 DOI: 10.1007/s43678-024-00687-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/27/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Indigenous health equity interventions situated within emergency care settings remain underexplored, despite their potential to influence patient care satisfaction and empowerment. This study aimed to systematically review and identify Indigenous equity interventions and their outcomes within acute care settings, which can potentially be utilized to improve equity within Canadian healthcare for Indigenous patients. METHODS A database search was completed of Medline, PubMed, Embase, Google Scholar, Scopus and CINAHL from inception to April 2023. For inclusion in the review, articles were interventional and encompassed program descriptions, evaluations, or theoretical frameworks within acute care settings for Indigenous patients. We evaluated the methodological quality using both the Joanna Briggs Institute checklist and the Ways Tried and True framework. RESULTS Our literature search generated 122 publications. 11 articles were selected for full-text review, with five included in the final analysis. Two focusing on Canadian First Nations populations and three on Aboriginal Australians. The main intervention strategies included cultural safety training, integration of Indigenous knowledge into care models, optimizing waiting-room environments, and emphasizing sustainable evaluation methodologies. The quality of the interventions was varied, with the most promising studies including Indigenous perspectives and partnerships with local Indigenous organizations. CONCLUSIONS Acute care settings, serving as the primary point of access to health care for many Indigenous populations, are well-positioned to implement health equity interventions such as cultural safety training, Indigenous knowledge integration, and optimization of waiting room environments, combined with sustainable evaluation methods. Participatory discussions with Indigenous communities are needed to advance this area of research and determine which interventions are relevant and appropriate for their local context.
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Affiliation(s)
- Tyara Marchand
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Kaitlyn Squires
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Oluwatomilayo Daodu
- Surgery, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Mary E Brindle
- Surgery and Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
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Lilley R, Davie G, Dicker B, Reid P, Ameratunga S, Branas C, Campbell N, Civil I, Kool B. Rural and Ethnic Disparities in Out-of-hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand. West J Emerg Med 2024; 25:602-613. [PMID: 39028247 PMCID: PMC11254149 DOI: 10.5811/westjem.18366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 12/13/2023] [Accepted: 01/18/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care. Methods This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients <85 years in age who were injured in a road traffic crash (RTC). In this study we examined the combined relationship between ethnicity and geographical location of injury in EMS out-of-hospital care and transport pathways following RTCs in Aotearoa-NZ. Analyses were stratified by geographical location of injury (rural and urban) and combined ethnicity-geographical location (rural Māori, rural non-Māori, urban Māori, and urban non-Māori). Results In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous Māori comprised 28% (196) of vehicle occupants attended by EMS, while 47% (324) of patients' injuries occurred in a rural location. The EMS transport pathways to hospital for rural patients were slower to reach first hospital (total in slowest tertile of time 44% vs 7%, P ≥ 0.001) and longer to reach definitive care (direct transport, 77% vs 87%, P = 0.001) compared to urban patients. Māori patients injured in a rural location were comparatively less likely than rural non-Māori to be triaged to priority transport pathways (fastest dispatch triage, 92% vs 97%, respectively, P = 0.05); slower to reach first hospital (total in slowest tertile of time, 55% vs 41%, P = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, P = 0.02). Conclusion Among RTC patients attended and transported by EMS in NZ, there was variability in out-of-hospital EMS transport pathways through to specialist trauma care, strongly patterned by location of incident and ethnicity. These findings, mirroring other health disparities for Māori, provide an equity-focused evidence base to guide clinical and policy decision makers to optimize the delivery of EMS care and reduce disparities associated with out-of-hospital EMS care.
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Affiliation(s)
- Rebbecca Lilley
- University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand
| | - Gabrielle Davie
- University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand
| | - Bridget Dicker
- Auckland University of Technology, Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland, New Zealand
- Hato Hone St John, Mt Wellington, Auckland, New Zealand
| | - Papaarangi Reid
- Waipapa Taumata Rau-University of Auckland, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Shanthi Ameratunga
- University of Auckland, School of Population Health, Section of Epidemiology and Biostatistics, Auckland, New Zealand
- Te Whatu Ora (Health New Zealand) Counties Manukau, Population Health Directorate, Auckland, New Zealand
- Monash University, Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
| | - Charles Branas
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York
| | - Nicola Campbell
- University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand
| | - Ian Civil
- Auckland District Health Board, Trauma Services, Auckland, New Zealand
| | - Bridget Kool
- University of Auckland, School of Population Health, Section of Epidemiology and Biostatistics, Auckland, New Zealand
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Farimani RM, Karim H, Atashi A, Tohidinezhad F, Bahaadini K, Abu-Hanna A, Eslami S. Models to predict length of stay in the emergency department: a systematic literature review and appraisal. BMC Emerg Med 2024; 24:54. [PMID: 38575857 PMCID: PMC10996208 DOI: 10.1186/s12873-024-00965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Prolonged Length of Stay (LOS) in ED (Emergency Department) has been associated with poor clinical outcomes. Prediction of ED LOS may help optimize resource utilization, clinical management, and benchmarking. This study aims to systematically review models for predicting ED LOS and to assess the reporting and methodological quality about these models. METHODS The online database PubMed, Scopus, and Web of Science (10 Sep 2023) was searched for English language articles that reported prediction models of LOS in ED. Identified titles and abstracts were independently screened by two reviewers. All original papers describing either development (with or without internal validation) or external validation of a prediction model for LOS in ED were included. RESULTS Of 12,193 uniquely identified articles, 34 studies were included (29 describe the development of new models and five describe the validation of existing models). Different statistical and machine learning methods were applied to the papers. On the 39-point reporting score and 11-point methodological quality score, the highest reporting scores for development and validation studies were 39 and 8, respectively. CONCLUSION Various studies on prediction models for ED LOS were published but they are fairly heterogeneous and suffer from methodological and reporting issues. Model development studies were associated with a poor to a fair level of methodological quality in terms of the predictor selection approach, the sample size, reproducibility of the results, missing imputation technique, and avoiding dichotomizing continuous variables. Moreover, it is recommended that future investigators use the confirmed checklist to improve the quality of reporting.
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Affiliation(s)
| | - Hesam Karim
- Department of Health Information Management, Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Atashi
- E-Health Department, Virtual School, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Tohidinezhad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kambiz Bahaadini
- Department of Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Ameen Abu-Hanna
- Medical Informatics, UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Medical Informatics, UMC Location University of Amsterdam, Meibergdreef, Amsterdam, The Netherlands.
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Marchand T, Daodu O, MacRobie A, Green-Dowden S, Brindle M. Examining Indigenous emergency care equity projects: a scoping review protocol. BMJ Open 2023; 13:e068618. [PMID: 37015788 PMCID: PMC10083800 DOI: 10.1136/bmjopen-2022-068618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION Indigenous peoples across the globe face inequitable access to high-quality care. Emergency departments are the first point of access for many Indigenous peoples and are the interface between the individual and the healthcare system. There is a reliance on emergency services due to a lack of primary healthcare, a history of mistreatment from providers and increased disease complexity. As such, a potential place for health equity reform is within these departments and other acute care settings. It is the purpose of this review to determine what projects have occurred that address emergency care inequities in four countries such as Australia, Canada, New Zealand and the USA and explore their successes and failures. METHODS AND ANALYSIS Using search strategies developed with a research librarian, publications will be identified from indexed databases including Medline, Embase, Web of Science, Cochrane Central, CINAHL and Scopus. Grey literature will also be searched and scanned for inclusion. To be included in the review, articles must describe interventions developed to address Indigenous health equity occurring within emergency care settings. Articles will include both programme descriptions and programme evaluations and be quality appraised by analysing study design and Indigenous research methodologies. ETHICS AND DISSEMINATION This review does not require ethics approval. This protocol describes a review that attempts to map Indigenous health equity interventions taking place within emergency care settings. It will contribute to Indigenous health scholarship and equity research. Results will be made available in multiple dissemination methods to ensure accessibility by researchers and community members.
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Affiliation(s)
- Tyara Marchand
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Ali MacRobie
- Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Mary Brindle
- Surgery, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Ariadne Labs, Boston, Massachusetts, USA
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Curtis E, Paine SJ, Jiang Y, Jones P, Tomash I, Healey O, Reid P. Examining emergency department inequities in Aotearoa New Zealand: Findings from a national retrospective observational study examining Indigenous emergency care outcomes. Emerg Med Australas 2021; 34:16-23. [PMID: 34651443 PMCID: PMC9293399 DOI: 10.1111/1742-6723.13876] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/02/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There is increasing evidence that EDs may not operate equitably for all patients, with Indigenous and minoritised ethnicity patients experiencing longer wait times for assessment, differential pain management and less evaluation and treatment of acute conditions. METHODS This retrospective observational study used a Kaupapa Māori framework to investigate ED admissions into 18/20 District Health Boards in Aotearoa New Zealand (2006-2012). Key pre-admission variable was ethnicity (Māori:non-Māori), and outcome variables included: ED self-discharge; ED arrival to assessment time; hospital re-admission within 72 h; ED re-presentation within 72 h; ED length of stay; ward length of stay; access block and mortality (in ED or within 10 days of ED departure). Generalised linear regression models controlled for year of presentation, sex, age, deprivation, triage category and comorbidity. RESULTS Despite some ED process measures favouring Māori, for example arrival to assessment time (mean difference -2.14 min; 95% confidence interval [CI] -2.42 to -1.86) and access block (odds ratio [OR] 0.89, 95% CI 0.87-0.91), others showed no difference, for example self-discharge (OR 0.98, 95% CI 0.97-1.00). Despite this, Māori mortality (OR 1.60, 95% CI 1.50-1.71) and ED re-presentation (OR 1.11, 95% CI 1.09-1.12) were higher than non-Māori. CONCLUSION To our knowledge, this is the most comprehensive investigation of acute outcomes by ethnicity to date in New Zealand. We found ED mortality inequities that are unlikely to be explained by ED process measures or comorbidities. Our findings reinforce the need to investigate health professional bias and institutional racism within an acute care context.
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Affiliation(s)
- Elana Curtis
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Peter Jones
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Emergency Medicine Research, Auckland City Hospital, Auckland, New Zealand
| | - Inia Tomash
- Emergency Department, Middlemore Hospital, Auckland, New Zealand
| | - Olivia Healey
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Curtis E, Paine S, Jiang Y, Jones P, Tomash I, Raumati I, Healey O, Reid P. Examining emergency department inequities: Descriptive analysis of national data (2006-2012). Emerg Med Australas 2020; 32:953-959. [PMID: 33207396 PMCID: PMC7756375 DOI: 10.1111/1742-6723.13592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Internationally, Indigenous and minoritised ethnic groups experience longer wait times, differential pain management and less evaluation and treatment for acute conditions within emergency medicine care. Examining ED Inequities (EEDI) aims to investigate whether inequities between Māori and non-Māori exist within EDs in Aotearoa New Zealand (NZ). This article presents the descriptive findings for the present study. METHODS A retrospective observational study framed from a Kaupapa Māori positioning, EEDI uses secondary data from emergency medicine admissions into 18/20 District Health Boards in NZ between 2006 and 2012. Data sources include variables from the Shorter Stays in ED National Research Project database and comorbidity data from NZ's National Minimum Dataset. The key predictor of interest is patient ethnicity with descriptive variables, including sex, age group, area deprivation, mode of presentation, referral method, Australasian Triage Scale and trauma status. RESULTS There were a total of 5 972 102 ED events (1 168 944 Māori, 4 803 158 non-Māori). We found an increasing proportion of ED events per year, with a higher proportion of Māori from younger age groups and areas of high deprivation compared to non-Māori events. Māori also had a higher proportion of self-referral and were triaged to be seen within a longer time frame compared to non-Māori. CONCLUSION Our findings show that there are different patterns of ED usage when comparing Māori and non-Māori events. The next level of analysis of the EEDI dataset will be to examine whether there are any associations between ethnicity and ED outcomes for Māori and non-Māori patients.
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Affiliation(s)
- Elana Curtis
- Te Kupenga Hauora Māori, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Sarah‐Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of ScienceThe University of AucklandAucklandNew Zealand
| | - Peter Jones
- Department of Surgery, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Inia Tomash
- Emergency Medicine ResearchAuckland City HospitalAucklandNew Zealand
- Emergency DepartmentMiddlemore HospitalAucklandNew Zealand
| | - Inia Raumati
- Emergency DepartmentAuckland City HospitalAucklandNew Zealand
| | - Olivia Healey
- Te Kupenga Hauora Māori, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
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Curtis E, Paine S, Jiang Y, Jones P, Tomash I, Raumati I, Reid P. Examining emergency department inequities: Do they exist? Emerg Med Australas 2019; 31:444-450. [PMID: 31060111 PMCID: PMC6849861 DOI: 10.1111/1742-6723.13315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Ethnic inequities in health outcomes have been well documented with Indigenous peoples experiencing a high level of healthcare need, yet low access to, and through, high-quality healthcare services. Despite Māori having a high ED use, few studies have explored the potential for ethnic inequities in emergency care within New Zealand (NZ). Healthcare delivery within an ED context is characterised by time-pressured, relatively brief, complex and demanding environments. When clinical decision-making occurs in this context, provider prejudice, stereotyping and bias are more likely. The examining emergency department inequities (EEDI) research project aims to investigate whether clinically important ethnic inequities between Māori and non-Māori exist. METHODS EEDI is a retrospective observational study examining ED admissions in NZ between 2006 and 2012 (5 976 126 ED events). EEDI has been designed from a Kaupapa Māori Research position. RESULTS The primary data source is the existing Shorter Stays in Emergency Department National Research Project (SSED) dataset that will be combined with clinical information extracted from NZ's National Minimum Dataset. The key predictor variable is patient ethnicity with other covariates including: sex, age-group, area deprivation, mode of presentation, referral method, Australasian Triage Scale and the Multimorbidity Measure (M3 Index) for co-morbidities. Generalised linear regression models will be used to investigate the associations between pre-admission variables and the measures of ED care, and to examine the contribution of each measure of ED care on ethnic inequities in mortality. CONCLUSION The present study will provide the largest, most comprehensive investigation of ED outcomes by ethnicity to date in NZ.
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Affiliation(s)
- Elana Curtis
- Te Kupenga Hauora Māori, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Sarah‐Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of ScienceThe University of AucklandAucklandNew Zealand
| | - Peter Jones
- Department of Surgery, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
- Emergency Medicine Research, Auckland City HospitalAucklandNew Zealand
| | - Inia Tomash
- Emergency DepartmentMiddlemore HospitalAucklandNew Zealand
| | - Inia Raumati
- Te Kupenga Hauora Māori, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
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Tomas I. Equity for Indigenous peoples in the emergency department: A Māori perspective. Emerg Med Australas 2018; 30:859-861. [PMID: 30456791 DOI: 10.1111/1742-6723.13196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Inia Tomas
- Emergency Department, Middlemore Hospital, Auckland, New Zealand
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