Racial And Ethnic Disparities in Care in the Psychiatry Consult Service at an Academic Hospital

Abstract: Background/Significance

Despite growing research in understanding how social determinants of health drive poor health outcomes, less is known about how racial disparities in health care at organizational, structural, and clinical levels impact medical care. In psychiatry, research in this area has mainly focused on disparities in availability and utilization of mental health services, emergency departments, and inpatient psychiatric services. More recently, the attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Race-based bias has been correlated and thought to play a role in the risk of physical restrain use [1], the types of diagnoses, quality of care, and medication prescription patterns in psychiatry [2]. Little is known about the role of race on the proportion and characteristics of consults placed in inpatient Consultation-Liaison Psychiatry services.



Methods

We are conducting a retrospective chart review using electronic health record (EHR) data of all adults for whom psychiatric consultation was requested during the study period. Our cohort consists of adults who were admitted to Massachusetts General Hospital and received psychiatric consultation from March through August 2021. Data gathered will include demographics, reason for consultation, phrasing of the consult question, medical and psychiatric history, treatment course, and outcomes (including psychiatric follow-up, use of restraints, legal hold, medications, medical outcomes, ultimate psychiatric diagnoses, and ultimate disposition) based on notes in the Electronic Health Record (EHR). Comparisons of these variables will be made between racial and ethnic minority groups and non-minority counterparts. We will also compare the proportion of placed consults to the overall MGH hospital racial minority admission rates.



Results

Data collection and analysis is currently in progress and should be complete by summer 2022. Overall, 1678 patients were seen by the consultation service during the study period. We will discuss the results of the study, with a focus on disparities in care of racial and ethnic minority patients by the primary and consultation services.



Discussion

Based on the results from identified cases, we will aim to expand the literature on how race-based bias affects patient care and outcomes in general medical hospitals and identify possible areas of intervention.



Conclusions

We hope the results of this study will provide a more refined understanding of the role of race-based bias on the characteristics of care provided in consultation psychiatry services, which may in turn facilitate interventions and mitigation thereof.







References



1. Schnitzer, K., et al., Disparities in Care: The Role of Race on the Utilization of Physical Restraints in the Emergency Setting. Acad Emerg Med, 2020. 27(10): p. 943-950.

2. Bareis, N., et al., Variation in Psychotropic Medication Prescription for Adults With Schizophrenia in the United States. Psychiatric Services, 2021: p. appi.ps.202000932.