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.

Public Health Relevance

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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Predoctoral Individual National Research Service Award (F31)
Project #
5F31NR013599-02
Application #
8472358
Study Section
National Institute of Nursing Research Initial Review Group (NRRC)
Program Officer
Banks, David
Project Start
2012-06-01
Project End
2015-05-31
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
2
Fiscal Year
2013
Total Cost
$42,232
Indirect Cost
Name
University of Pennsylvania
Department
None
Type
Schools of Nursing
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104