Study Finds Black Patients More Likely to Have Negative Descriptors in Medical Records
- January 21, 2022
Black patients had 2.54 times the odds of White patients of having at least one negative descriptor in their medical records, according to a study published January 19 in the online journal Health Affairs.
The study’s findings of disproportionate use of negative patient descriptors for Black patients indicates racial bias, which has the potential to “stigmatize Black patients and possibly compromise their care, raising concerns about systemic racism in health care,” the study said.
The study used machine learning to analyze electronic health records from an urban academic medical center to investigate whether providers’ use of negative patient descriptors varied by patient race or ethnicity. The study looked at a sample of 40,113 history and physical notes (January 2019–October 2020) from 18,459 patients for sentences containing a negative descriptor, such as “refused,” “(not) adherent,” “agitated,” or “(not) compliant.”
According to the study, patients with Medicaid or Medicare also had higher adjusted odds of a negative descriptor compared with patients with private or employer-based insurance and unmarried patients had higher adjusted odds of a negative descriptor compared with married patients.
Although the study noted that it was performed at a single urban academic medical center, and thus had limited generalizability, it called for increased attention to structural racism in the health care context. “Implicit bias has clear negative effects on provider communication, trust in medical care, and the delivery of health care to racially marginalized populations,” the authors said.
Negative descriptors written in the admission history and physical may be likely to be copied into subsequent notes, recommunicating and amplifying potential biases, which “underscores the responsibility of providers who document the initial patient encounter to do so in an aware and sensitive manner,” the study said.
Read the study, Negative Patient Descriptors: Documenting Racial Bias in The Electronic Health Record