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  • Alex Caches

Racial and Ethnic Disparities in ICU Care – Current Research at Michigan Medicine

Despite recent efforts and movements for racial and ethnic equity and equality in the United States, racial and ethnic disparities are evident in intensive care units (ICUs), specifically related to medical ventilation practices. Timely and effective care for respiratory failure is essential for saving lives in ICU care, however, the effectiveness of medical ventilation practices is underscored by the lives of racial and ethnic minorities, who are twice as likely to develop respiratory failure as white people. An ongoing study, led by Dr. Thomas valley and Amanda Schutz through the Pulmonary and Critical Care Department at Michigan Medicine, grasps the enduring problem in critical care of detecting, understanding, and eliminating racial and ethnic inequities through a systematic review process and meta-analyses of medical literature. An analysis of this literature through full-text reviews will yield evidence of the pervasive disparities in rates of respiratory failure between minorities and white people, with focus on Hispanic populations, as well as the rise of mortality rates among racial and ethnic minorities. There is an urgent need to bridge the knowledge gap of understanding the decision-making process of ICU clinicians. Intervention calls for mitigating ethnic disparities in ICU care, which in turn can save lives. The overall objective of the research is to reduce inequitable outcomes of respiratory failure by improving ICU care. Information provided by current literature is a major part of this research, which involves designing an intervention to promote racial equity in respiratory failure, prototyping through patient, family, and clinician engagement and piloting at two ICUs.

Under the help and guidance of the lead researchers on the research team, I worked alongside another undergraduate student to conduct a systematic review that will eventually conclude with a full-text review and data extraction. The procedures of the study involve a review process of medical literature in order to design, prototype, and pilot an intervention targeting mechanical ventilation practices associated with inequitable care process delivery and outcomes based upon race and ethnicity, specifically ethnic disparities experienced by Hispanic and Latinx populations. The first objective was to develop review protocol eligibility of studies to be included or excluded in the review, based on PICO elements. A qualitative research question was developed based on PICO elements: population, intervention, comparison intervention, and outcome. After developing this question, we were able to start a comprehensive search to identify all relevant studies involving a population of adult patients with acute respiratory failure who received mechanical ventilation. We compared white and Hispanic/Latinx populations through outcomes such as mortality rates, length of stay, and amount of time on ventilation. Second, we developed a search strategy by creating a list of search terms with Boolean operators to find relevant medical literature for our review through databases such as PubMed and Web of Science. Then, we ran our search with the finalized search terms, compiling the literature onto Covidence, where we began the screening process.

We are currently still working on the screening process and in selecting literature that meets the inclusion and exclusion criteria that we developed. This will be followed by a full-text review, data extraction and data synthesis, in which we will closely read the included studies and extract results relevant to the research question. Further steps involve a meta-analysis, which is used for systematically assessing and combining the results of two or more studies, with an aim of producing an overall summary effect of the results. Meta-analysis can be used to explore the differences in the effects of the intervention, and the reasons for those differences through meta-synthesis.

As a result of this research thus far, we have been able to establish and identify that there are evident racial and ethnic disparities in pulmonary and critical care. For this reason, the expected results of the analysis of the systematic reviews we will conduct include interventions - in efforts to reduce these disparities in intensive care units - especially in relation to pulmonary and critical care.

The implications of this research are especially evident in the COVID-19 pandemic, where racial disparities have become increasingly prevalent, according to high mortality and infection rates being in non-white populations compared to white populations. The global implications of this research lie in how we can improve health care in future public health crises by not only having an understanding of the racial disparities prevalent in health care and research, but while also making an effort to combat these inequalities.

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