Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: acute coronary syndrome; cardiovascular emergencies; clinical guidelines; cost-effectiveness; health care delivery; health policy; infectious diseases; outcomes.