Health Policy Journal Club, Health Policy, Advocacy

Health Policy Journal Club: Socially Constructed Criticisms

Socially constructed categorizations continue to limit quality of care for minorities

Your race or ethnic background may play a role in analyzing whether you receive pain treatment when seeking emergency medical services. Considerable evidence suggests systematic disparities in hospitals in which racial/ethnic minorities receive care and associated disparities in patient outcomes compared with hospitals frequented by White patients. However, racial/ethnic treatment disparities in the field of Emergency Medical Services (EMS) remains relatively less understood.

EMS treats an estimated 16 million sick and injured individuals annually, often with acute morbidity and mortality. recent retrospective study determined that racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with White patients.

Of more than 25,000 EMS encounters from 2015-2017, Hispanic patients were 21% less likely and Asian patients were 31% less likely to receive pain assessment and pain medication when compared with White patients. The adjusted likelihood of receiving any pain medications demonstrated that Black patients were 32% less likely, Hispanic patients were 21% less likely, and Asian patients were 24% less likely when compared with White patients. The results imply that race/ethnicity, a socially constructed categorization scheme rooted in relationships of power, continues to limit quality medical treatment for minorities.

Previous research suggests mechanisms driving racial/ethnic disparate treatment may operate at the patient, provider, and institutional level. The authors of this study postulate, at the patient level, limited English proficiency is likely relevant to receiving lower quality medical treatment in emergency medicine.

At an institutional level, clinical situations that require medical professionals to perform under high levels of cognitive load have been shown to create environments that are conducive to racial/ethnic treatment disparities through activation of heuristics and stereotypes known to contain bias. It may be likely that EMS personnel maybe adjusting their clinical actions similarly. To mitigate treatment disparities, agencies could explore diverse training and recruitment options. Regulators might consider creating local policies overseeing EMS agencies to make data available that EMS treatment is being provided equitably. These data could ultimately impact the care of minorities by EMS.


Abstract: Kennel J, Withers E, Parsons N, Woo H. Racial/ethnic disparities in pain treatment: evidence from Oregon Emergency Medical Services agencies. Med Care. 2019;57(12):924-929.

BACKGROUND: Despite the critical role that EMS plays in the health care system, racial/ethnic treatment disparities in EMS remain relatively unexamined.

OBJECTIVE: To investigate racial/ethnic treatment disparities in pain assessment and pain medication administration in EMS

RESEARCH DESIGN: A retrospective analysis was performed on 25,732 EMS encounters from 2015 to 2017 recorded in the Oregon Emergency Medical Services Information System using multivariate logistic regression models to examine the role of patient race/ethnicity in pain assessment and pain medication administration among patients with a traumatic injury

RESULTS: Hispanic and Asian patients were less likely to receive a pain assessment procedure and all racial/ethnic patients were less likely to receive pain medications compared with white patients. In particular, regarding the adjusted likelihood of receiving a pain assessment procedure, Hispanic patients were 21% less likely [95% confidence interval (CI), 10%-30%; P<0.001], Asian patients were 31% less likely (95% CI, 16%-43%; P<0.001) when compared with white patients. Regarding the adjusted likelihood of receiving any pain medications, black patients were 32% less likely (95% CI, 21%-42%; P<0.001), Hispanic patients were 21% less likely (95% CI, 7%-32%; P<0.01), and Asian patients were 24% less likely (95% CI, 1%-41%; P<0.05) when compared with white patients.

CONCLUSIONS: Racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services in Oregon for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with white patients.

PMID: 31730566


EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA

As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care providers, and the lack of mental health services - are universal problems. As EM residents and fellows,  we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula. This is the gap this initiative aims to fill.  Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.