Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA.
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Acad Emerg Med. 2021 Sep;28(9):1051-1060. doi: 10.1111/acem.14235. Epub 2021 Jun 28.
Evidence-based guidelines are often cited as a means of ensuring high-quality care for all patients. Our objective was to assess whether emergency department (ED) adherence to core evidence-based guidelines differed by patient sex and race/ethnicity and to assess the effect of ED guideline adherence on patient outcomes by sex and race/ethnicity.
We conducted a preplanned secondary analysis of data from a multicenter retrospective observational study evaluating variation in ED adherence to five core evidence-based treatment guidelines including aspirin for acute coronary syndrome, door-to-balloon time for acute ST-elevation myocardial infarction, systemic thrombolysis for acute ischemic stroke, antibiotic selection for inpatient pneumonia, and early management of severe sepsis/septic shock. This study was performed at six hospitals in Colorado with heterogeneous and diverse practice environments. Hierarchical generalized linear modeling was used to estimate adjusted associations between ED adherence and patient sex and race/ethnicity while controlling for other patient, physician, and environmental factors that could confound this association.
A total of 1,880 patients were included in the study with a median (IQR) age of 62 (51-74) years. Males and non-Hispanic whites comprised 59% and 71% of the cohort, respectively. While unadjusted differences were identified, our adjusted analyses found no significant association between ED guideline adherence and sex or race/ethnicity. Patients who did not receive guideline adherent care in the ED were significantly more likely to die while in the hospital (odds ratio = 2.0, 95% confidence interval = 1.3 to 3.2).
Longstanding, nationally reported evidence-based guidelines can help eliminate sex and race/ethnicity disparities in quality of care. When providers know their care is being monitored and reported, their implicit biases may be less likely to impact care.
循证指南常被认为是确保所有患者获得高质量医疗的手段。我们的目的是评估急诊（ED）对核心循证指南的遵循情况是否因患者性别和种族/民族而异，并评估 ED 指南遵循情况对不同性别和种族/民族患者结局的影响。
我们对一项多中心回顾性观察性研究的数据进行了预先计划的二次分析，该研究评估了 ED 对 5 项核心循证治疗指南的遵循情况的差异，包括急性冠状动脉综合征患者使用阿司匹林、急性 ST 段抬高型心肌梗死患者门球时间、急性缺血性脑卒中患者使用全身溶栓、住院肺炎患者使用抗生素选择和严重脓毒症/脓毒性休克的早期管理。该研究在科罗拉多州的 6 家医院进行，这些医院的实践环境具有异质性和多样性。使用分层广义线性模型来估计 ED 遵循情况与患者性别和种族/民族之间的调整关联，同时控制其他可能使这种关联产生混淆的患者、医生和环境因素。
共有 1880 名患者纳入研究，中位（IQR）年龄为 62（51-74）岁。男性和非西班牙裔白人分别占队列的 59%和 71%。尽管存在未调整的差异，但我们的调整分析发现 ED 指南遵循情况与性别或种族/民族之间没有显著关联。在 ED 未接受指南遵循治疗的患者在住院期间死亡的风险显著增加（比值比=2.0，95%置信区间=1.3 至 3.2）。
长期以来，全国范围内报告的循证指南可以帮助消除医疗质量方面的性别和种族/民族差异。当提供者知道他们的护理正在被监测和报告时，他们的隐性偏见可能不太可能影响护理。
