Table 2.

Potential New Measure Concepts for Health Disparities in Emergency Care

Emergency Medicine Health Disparities Framework Domain	Structure Measures	Process Measures	Outcome Measures
Access	24/7 interpreter services Availability of on-call specialists at safety-net facilities	Rate of interpreter use for non-English speaking patients Racial differences in hallway use, vertical space, waiting room care and other alternate sites of care	Racial differences in left without being seen rate Racial differences in risk-adjusted transfer rate
Care Delivery	Universal collection of self-reported race and ethnicity data in EHR Implementation of clinical protocols for the care of disparities sensitive conditions (ex. substance use disorder, sickle cell pain crisis)	Completeness of self-reported race and ethnicity data Use of stigmatizing language in medical record Adherence to clinical guidelines for patients with acute sickle cell pain crisis	Racial differences in use of sedation and physical restraints for acute agitation Patient experience of justice-involved individuals Racial differences in left against medical advice
Transitions	Access to social work services in ED, including after hours	Quality and completeness of handoff to higher level of care Completion of medically necessary follow-up care for acute illness or injury (ex. fracture)	Risk-adjusted return ED visit Risk-adjusted inpatient and ICU admission rates
Structural and Environmental	Implicit bias training for clinicians Availability of social risk screening	Referral to community resources for identified social needs	Concordance between ED patient population and local community race, ethnicity, and payer mix