Interventions to improve racial and ethnic equity in critical care: A scoping review.

Abstract

Racial and ethnic disparities in the delivery and outcomes of critical care are well documented. However, interventions to mitigate these disparities are less well understood. We sought to review the current state of evidence for interventions to promote equity in critical care processes and patient outcomes. Four bibliographic databases (MEDLINE/PubMed, Web of Science Core Collection, CINAHL, and Embase) and a list of core journals, conference abstracts, and clinical trial registries were queried with a pre-specified search strategy. We analyzed the content of interventions by categorizing each as single- or multi-component, extracting each intervention component during review, and grouping intervention components according to strategy to identify common approaches. The search strategy yielded 11,509 studies. Seven-thousand seventeen duplicate studies were removed, leaving 4,491 studies for title and abstract screening. After screening, 93 studies were included for full-text review. After full-text review by two independent reviewers, eleven studies met eligibility criteria. We identified ten distinct intervention components under five broad categories: education, communication, standardization, restructuring, and outreach. Most examined effectiveness using pre-post or other non-randomized designs. Despite widespread recognition of disparities in critical care outcomes, few interventions have been evaluated to address disparities in the ICU. Many studies did not describe the rationale or targeted disparity mechanism for their intervention design. There is a need for randomized, controlled evaluations of interventions that target demonstrated mechanisms for disparities to promote equity in critical care.