Assessment of Patent Diversity and Equity of Care in a Tertiary Referral Interventional Pain Medicine Clinic

Objective: As an academic tertiary care interventional pain clinic, referrals are screened to ensure patients most likely to benefit from our services are accepted into the practice. The objective of this study is to assess for unconscious bias in the patient selection process. Study Design: The demographic data of patients accepted into the practice was compared to patients not offered an appointment as a result of the screening process. Setting: A university-based interventional pain center seeing patients referred from within the institution and broader community. Methods: Three data management systems including an electronic health record, an appointment management system, and a financial records system, were queried to extract the patient characteristics and demographic data for all patients referred to the clinic between January 1, 2018, and December 31, 2019. Data were then analyzed for differences across these demographic characteristics to assess for unconscious bias. Results: There were 3,465 patients meeting the criteria; 2975 were offered an appointment and 490 were not. The ages and genders were not clinically different between groups. There was a significant difference in the percentage of patients identifying as Hispanic being offered an appointment (1.82%) vs not being offered an appointment (3.88%) (P = 0.0016). There were no statistical differences in the race or preferred language of patients accepted for an appointment versus declined. Conclusions: While the screening process did not result in disparities across age, gender, race, or language preference, there was a statistical difference in patients identifying as Hispanic. As a result of this study, all patient identification has been removed from the review document to limit the likelihood of unconscious bias.