Indian-American professors in team of researchers studying racism in emergency care


A team of researchers including two Indian-American professors at the University of Pennsylvania used a new method to garner details about experiences of patients in emergency care situations.

Anish Agarwal. Photo Twitter @AgarwalEM
Raina Merchant. Photo Twitter @RainaMerchant

Anish Agarwal and Raina Merchant along with Eugenia South, all from the Perelman School of Medicine, along with Wharton School researchers used text messaged-based surveys to assess patient emergency department experience, including the impact of race, a report on the university outlet said.

Most studies in health care in the United States report racially-based discrimination, putting Black patients at the receiving end of less care compared to white patients, and higher mortality rates among the former.

“Most health systems assess patient experience with surveys, but the questions do not ask about racism,” according to the UPenn article. To meet this gap, Agarwal et all’s study using the text-messaged surveys seeking to get more pinpointed data on the impact of race. The study, entitled, “Assessing experiences of racism among Black and White patients in the emergency department” carried last December in the Journal of the College of Emergency Physicians Online Library, is reported by Jan. 6, 2023.

“For a significant number of Black patients, race negatively impacted their care, including communication, quality, and respect,” says the ‘Conclusion’ of the study abstract appearing on the JACEP online website. “Health systems lack methods that specifically identify patient experiences of racism. We demonstrate the feasibility of using text messaging to collect patient-reported experiences of racism,” the researchers found.

“The objective of this study was to investigate the differences in patient-reported experiences related to emergency department (ED) care using a post-discharge text messaging survey,” an abstract of the study notes on the JACEP website.

The study was conducted for 7 weeks between August 6 and September 24, 2021. Participants included adults (aged ≥18 years) discharged from 2 urban, academic Emergency Departments with an active mobile phone number in the electronic health record.

The primary outcome of interest was patient-reported impact of race on overall rating of ED care. Secondary outcomes included overall satisfaction with care and perceived impact of race on components of care, including respect, communication, and quality of care.

A total of 590 (14%) discharged patients consented, and 462 patients completed the entire survey. The mean age was 43 years (SD 17.3); 67% were women, and 60.0% were Black.

Black patients reported a higher overall rating of ED care (median 5 [3, 5]; P = 0.013). Proportionately, when compared with White patients, more Black patients reported that race negatively impacted the rating of care (10.8% vs 1.4%; P = 0.002). More than a quarter of Black patients (27.4%) reported race highly impacting being treated with respect (P = 0.024), and 22.4% reported a high impact on quality of service (P = 0.003) when compared with White patients.

“Inequity—specifically across race—has led to significant disparities in patient care and outcomes that persist in health care,” Agarwal is quoted saying in the  article. “We need to find ways to measure experiences of racism and address it.”

Agarwal contends that the way to improve clinical care and dismantling structural racism across society, and within health care, requires specific attention.

“We currently do not have ways to directly address or even investigate this critical aspect of health care,” he told Penntoday, adding that his team’s study exposes some of the nuanced challenges of deriving patient-centered responses during ER treatment.



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