'Difficult patient' flag leads to treatment disparities, researchers say

Behavioral flags in electronic health records are designed to to help prevent violence against clinicians, but the flags might also prevent some patients from receiving full care, according to a recent study.

A retrospective study published Jan. 19 in JAMA Network Open analyzed more than 426,000 emergency room visits in three Philadelphia hospitals between January 2017 and December 2019. Of more than 195,000 patients included in the analysis, 683 had a behavioral flag.

Researchers found patients with flags were likely to have one of more of the following characteristics: male, Black or have Medicaid insurance. Researchers also found flags led to some healthcare disparities:

  • Black patients received nearly twice as many flags as white patients (4 per 1000 patients versus 2.4 per 1000).

  • Among patients with a flag, Black patients had longer wait times compared with white patients — 10 minutes longer to be placed in a room and roughly nine minutes longer to see a clinician — but had shorter lengths of stay by nearly 40 minutes.

  • Of Black patients with a flag, 43 percent received no lab tests and 63 percent had no imaging, compared with 36 percent and 56 percent, respectively, for white patients.

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