Identifying and Addressing Health Disparities Among Hispanic Adults in the Intensive Care Unit: A Needs Assessment

The existence of health disparities among Hispanic adults in the critical care setting has been well documented. Multifactorial causes are often implicated but clear characterizations for health disparities in this setting have not been identified. The purpose of this needs assessment was to investigate whether health disparities exist among Hispanic patients admitted to the ICU in a small community hospital serving a large Hispanic population and to understand the underlying causes of identified disparities. The Hispanic population in the state where the study was conducted is 13% but the city and site of the study has a 38% Hispanic population. A retrospective chart review (N= 246) was performed at a community hospital on patients ages 18-64, admitted to the ICU between January 1, 2015 and January 1, 2016. Data were extracted from the electronic health record using a checklist that included admitting diagnosis, race/ethnicity, occupation, educational level, substance use information, insurance status, education provided during hospitalization, discharge disposition and other variables. Meetings with facility and community stakeholders were completed to present the findings of the identified disparities. Targeted recommendations were presented identifying hospital and community strategies to reduce Hispanic disparities. Descriptive statistics were used to analyze chart review results. Demographic disparities included age and insurance status. Hispanic patients were, on average younger, than non-Hispanic white patients, 41 (+ 14.1) vs. 46 (+ 13.1) years respectively p = .026. Non-Hispanic white patients had higher insured rates p = .005. Hispanic patients had higher rates of overdose-related admissions (28.89%) compared to non-Hispanic white patients (16.42%, p = .026) however on discharge overdose rates in non-Hispanic white patients had comparable overdose diagnostic rates (20.40%) compared to Hispanic patients (28.89%), p=.106). On discharge, Hispanic patients had higher rates of alcohol/drug abuse and related induced mental disorders (22.22%) than non-Hispanic white patients (11.44%, p = .027). For Hispanic patients listed as Spanish speaking only, documentation on the use of interpreter services was not found. No significant differences were found in other variables assessed such as, time to hospital presentation, readmission rates, and education provided during admission. Recommendations made to stakeholders included increasing interpreter use for Spanish speaking only patients, assessing the underlying cause of drug/alcohol abuse among Hispanic patients in the ICU and providing more targeted education on overdose prevention to at risk individuals.