Impacting recoveries and positive outcomes

Less frequent pain monitoring has much more significant consequences than mere patient discomfort. Jetley and his coauthor cite a wealth of peer-reviewed studies that link improved pain management to higher treatment success rates. Inspired by this body of work, they hypothesized that disparities in pain treatment would lead to measurable differences between recoveries for Black and white patients after they left intensive care.

Using mediation analysis on a population of about 18,600 patients, Jetley and his coauthor compared early readmission rates of ICU patients – those who returned to the hospital within 30 days of discharge – and found that Black patients’ likelihood of readmission was significantly higher than white patients. What’s more, researchers found that this higher likelihood of readmission for Black patients can be (partially) explained by Black patients receiving significantly lower amount of pain measurements during their ICU stay.

“We wanted to look at certain causal impacts with secondary data, and I was pretty surprised that there was a noticeable and significant impact on readmission,” Jetley said. “This is something that’s not been seen in healthcare literature.”

Reaffirming the findings

While these findings were intriguing, the researchers needed to further explore the data to be confident that differences in pain measurement between Black and white patients could explain the racial disparities in readmission rates in different patient subgroups as well. This took some clever use of proxy data to tease out additional insights.

First, researchers looked at readmission rates between surgical and non-surgical procedures. Recovery from surgery typically has a much more structured approach to pain management than other treatment, which reduced pain measurement gaps between patients of different races. In this population, researchers found no strong evidence linking race to pain measurement frequency and early readmission. In contrast, the findings from the study held in the non-surgical population of patients.

Jetley and his coauthor then examined readmission rates for patients who were more (or less) severe or had more (or less) complex conditions. More severe and complex patients are often in a more delicate condition and may be more likely to be impacted by disparities in pain measurements as compared to their counterparts. They found that the effect of lower pain measurement frequency for Black patients on readmission rates held and was amplified for a more severe and complex patient population.

The implications were hard to miss: Black patients receive worse pain management and in turn, are more likely to return to the hospital because of it.

The costs of poor pain management

From a social justice perspective, the outcome inequality between Black and white patients is clearly unacceptable, but Jetley’s findings also have deep financial ramifications for the healthcare industry. About half of all hospital visits are readmissions, and nearly 75% of those are preventable. Addressing the biases Jetley identifies in his research could have profound savings for private hospitals, insurers and the taxpayers who foot the bill for federal programs.

“Disparities in pain management not only is worse for the patients, but it also increases overall healthcare costs in the entire U.S.,” Jetley said. “It also reduces the hospitals’ reimbursements due to higher readmission rates.”

The good news is that progress is achievable, Jetley says. While eradicating racial bias is a problem much broader than the medical industry, managers can develop protocols to correct for those biases and see reductions in readmission rates. Better acknowledgement of inherent biases can also help healthcare professionals work to address personal growth to eliminate them.

“Training is part of the solution, because these biases can be unintentional,” Jetley said. “Everyone can have biases in their mind, and sometimes they can result in these observable outcomes. Sometimes these observable outcomes can actually lead to dire consequences.”