Morisod Kevin, Luta Xhyljeta, Marti Joachim, Spycher Jacques, Malebranche Mary, Bodenmann Patrick
Department of Vulnerabilities and Social Medicine, Centre for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.
Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Health Equity. 2021 Dec 1;5(1):801-817. doi: 10.1089/heq.2021.0035. eCollection 2021.
Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care. We conducted a systematic review of administrative data-derived health care equity indicators and their association with socioeconomic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PubMed, and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care-sensitive condition-related ED visits were the two most frequently used equity indicators. The studies analyzed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy, and financial and nonfinancial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care. The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded measurement of health care equity than using any one indicator in isolation. Although studies analyzed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.
实现医疗保健公平仍是全球医疗保健系统面临的一项挑战，在医疗服务的可及性和质量方面仍存在显著的不公平现象。确定医疗保健公平指标是将公平概念纳入医疗保健系统绩效评估的重要第一步，尤其是在急诊护理方面。我们对行政数据衍生的医疗保健公平指标及其与急诊护理环境中健康的社会经济决定因素（SEDH）之间的关联进行了系统评价。遵循PRISMA-Equity报告指南，检索了Ovid MEDLINE、EMBASE、PubMed和Web of Science以查找相关研究。感兴趣的结果是医疗保健公平指标及其所研究的相关SEDH。在确定的29项研究中，确定了14项公平指标，并将其分为反映患者急诊护理路径的四类。急诊室（ED）就诊总数和与门诊护理敏感状况相关的ED就诊是最常用的两项公平指标。这些研究基于七个SEDH分析了公平性：社会剥夺、收入、教育水平、社会阶层、保险覆盖范围、健康素养以及财务和非财务障碍。尽管存在一些相互矛盾的结果，但所有确定的SEDH都与急诊护理的可及性和使用方面的不平等有关。将行政数据衍生指标与确定的SEDH结合使用，可以改善全球医疗保健系统中急诊护理环境下医疗保健公平性的衡量。与单独使用任何一个指标相比，使用多种指标组合可能会导致对医疗保健公平性进行更全面、更全面的衡量。尽管所分析的研究侧重于急诊护理环境，但似乎有可能推断这些指标以衡量医疗保健系统其他领域的公平性。需要进一步开展研究，以阐明医疗保健系统内外健康不平等的根本原因。
