Network Analysis of Clinical Interactions in the Emergency Department: Patient Race, Acuity, and Network Centrality Restricted; Files Only
Flynn, Tommy (Spring 2024)
Abstract
Background: Racial healthcare disparities are well documented in the emergency department (ED) quality literature, especially those that disadvantage Black patients compared to White. Disparities in ED quality are thought to be affected by differences in clinical interactions (CIs). CIs are face-to-face encounters in the context of healthcare delivery and represent the most common mode of communication in the ED. Despite the importance of CIs in ED communication and reducing racial healthcare disparities, it is unknown whether CIs differ for Black and White ED patients. CIs in EDs create a set of human interactions that may be best understood from a network perspective using centrality measures. Centrality measures are thought to capture the relative activity of individuals in a network. Patients’ network centrality in the ED CI network, therefore, should indicate the relative engagement that patients receive from ED staff.
Objective: The objective of this dissertation was to use network analysis of clinical interactions (NACI) as a novel approach to studying racial disparities and patient acuity in the ED.
Methods: To meet this objective, we developed three interrelated but distinct studies including a mixed-methods systematic review and two data-based studies. The two data-based studies were both secondary analyses of ED CI network data that explored the use of NACI to describe differences in the network centralities of Black compared to White patients and by triage acuity level, respectively.
Results: Extant research on racial disparities in ED CIs was limited, especially research focused on observed CI processes. We found no evidence of differences in network centrality indices for Black compared to White ED patients. Patient acuity was not related to network centrality and lower acuity patients trended toward high centrality compared to higher acuity patients.
Conclusions: Despite a sizeable body of literature on racial disparities in ED quality metrics, evidence of disparities in ED CIs is lacking both breadth and depth. The two data-based studies add to the literature on observed CI processes and demonstrate the application of the NACI approach. The NACI approach is discussed as a novel application to study clinical phenomena like racial healthcare disparities and patient acuity.
Table of Contents
List of Tables 7
List of Figures 8
Acknowledgements 9
Chapter 1 - Introduction 10
Chapter 2 - Patient Race and Clinical Interactions in the Emergency Department: A Mixed-Methods Systematic Review 18
Chapter 3 - Network Analysis of Clinical Interactions in the Emergency Department: Patient Race and Network Centrality 52
Chapter 4 - Emergency Department Triage Scores and Patients’ Network Centrality: A Network Analysis of Clinical Interactions 78
Chapter 5 - Conclusion 107
References 113
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File download under embargo until 22 May 2025 | 2024-04-04 05:48:32 -0400 | File download under embargo until 22 May 2025 |
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