Despite comparable severity of injury and burden of comorbidities, minority patients experience poorer outcomes from traumatic injuries when compared to their White peers with the same injury, health characteristics, and insurance status. There is evidence of inequities both in injury mortality and in the experiences of survivors. Patients belonging to racial and ethnic minorities are more likely to die after traumatic injury in America's hospitals. Those that survive are less likely to be discharged to comprehensive rehabilitation facilities and describe uncertainty, distrust, and feelings of vulnerability when reflecting upon interaction with trauma care providers. There is a dearth of research that investigates the way that interactional phenomenon (bias, stereotyping, and uncertainty in race-discordant patient-clinician interactions) contributes to the development of these health disparities. Focused descriptive inquiry on the experience of minority trauma patients cared for in America's hospitals is needed to fill this gap. The purpose of this proposed research is to describe the experiences of Black urban trauma patients to understand how and why care practices and clinician-patient interactions might manifest in poorer outcomes among minority patients. A qualitative inquiry, using participant observation and embedded interview, inclusive of both patient and clinician perspectives, will be used to explore these interactional processes throughout the hospitalization experience - from emergency department to hospital discharge. Black trauma patients are selected as the population of interest because they comprise a disproportionately high percentage of minority patients presenting to hospitals for injury treatment. Citing this research in an urban trauma center is ideal because these institutions are often situated in areas of racial and ethnic diversity, designated as centers equipped to treat a large spectrum of injury type and severity, and typically have a higher census of injured patients than smaller non-urban medical centers. With an enhanced understanding of the experiences of Black patients in the urban trauma care system, we will be able to alter processes of care to improve outcomes and test health-promoting interventions designed to: reduce disparities in injury outcomes, prevent re-injury and build positive connections to other health services essential in facilitating an optimal recovery. This research will build the foundation for the applicant's the long term goal of developing a program of research to explore the social, economic and environmental determinants of inequities in injury risk and outcomes, in order to inform interventions aimed at building greater equity in access to and provision of care for the traumatically injured. The goals of this project are well aligned with NINR's priority to reduce an eliminate health disparities.
Despite comparable severity of injury and burden of comorbidities, minority patients experience poorer outcomes from traumatic injuries when compared to their White peers with the same injury, health characteristics, and insurance status. It is essential that the social aspects of trauma care that may contribute to poorer outcomes, including in-hospital processes, are better understood. With an enhanced understanding of the experiences of Black patients in the trauma care system, we will be better positioned to alter processes of care to improve outcomes and test appropriate health-promoting interventions designed to reduce health disparities.
|Jacoby, Sara F; Richmond, Therese S; Holena, Daniel N et al. (2018) A safe haven for the injured? Urban trauma care at the intersection of healthcare, law enforcement, and race. Soc Sci Med 199:115-122|
|Abboud, Sarah; Kim, Su Kyung; Jacoby, Sara et al. (2017) Co-creation of a pedagogical space to support qualitative inquiry: An advanced qualitative collective. Nurse Educ Today 50:8-11|
|Jacoby, Sara F (2017) The insight and challenge of reflexive practice in an ethnographic study of black traumatically injured patients in Philadelphia. Nurs Inq 24:|
|Jacoby, Sara F; Shults, Justine; Richmond, Therese S (2017) The effect of early psychological symptom severity on long-term functional recovery: A secondary analysis of data from a cohort study of minor injury patients. Int J Nurs Stud 65:54-61|
|Jacoby, Sara F; Winston, Flaura K; Richmond, Therese S (2017) Road safety perspectives among employees of a multinational corporation in urban India: local context for global injury prevention. Int J Inj Contr Saf Promot 24:493-500|
|Jacoby, Sara F; Tach, Laura; Guerra, Terry et al. (2017) The health status and well-being of low-resource, housing-unstable, single-parent families living in violent neighbourhoods in Philadelphia, Pennsylvania. Health Soc Care Community 25:578-589|
|Tach, Laura; Jacoby, Sara; Wiebe, Douglas J et al. (2016) The Effect of Microneighborhood Conditions on Adult Educational Attainment in a Subsidized Housing Intervention. Hous Policy Debate 26:380-397|