SHM Converge Scientific Abstract ePoster Gallery-Disparities in Use of Stigmatizing Language for Behavioral Alerts of Hospitalized Patients

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This study examined whether stigmatizing language appears disproportionately in hospital behavioral alerts, which are prominent and semi-permanent notes in the patient chart. Researchers reviewed all behavioral alerts for patients admitted to or discharged from UCSF Hospital Medicine between January 2016 and June 2021, totaling 45,272 patient encounters and 439 patients with behavioral alerts.<br /><br />They flagged alert language as potentially stigmatizing if it contained terms such as “abusi,” “abuse,” “junki,” “aggress,” “pain-seeker,” “user,” “frequent flyer,” or “narcotic.” They then compared use of this language across patient characteristics including age, sex, race, ethnicity, marital status, psychiatric diagnosis, and insurance type.<br /><br />Among the 439 patients with behavioral alerts, 261 alerts contained stigmatizing language. Multivariable analysis showed that stigmatizing language was more likely to appear in alerts for patients who were younger, unmarried, publicly insured, or had a psychiatric diagnosis. Specifically, psychiatric diagnosis had the strongest association with stigmatizing language, while Medicare and Medicaid coverage were also linked to higher odds. Female sex and Hispanic/Latino ethnicity were associated with lower odds of stigmatizing language; race was not significantly associated.<br /><br />The authors conclude that behavioral alerts may reflect and reinforce bias against vulnerable patient groups. Because these alerts are visible to many clinicians and remain in the chart, their stigmatizing content could contribute to ongoing discrimination in care.

Asset Subtitle

Adrià Jiménez Bacardí

Meta Tag

Author List Adrià Jiménez Bacardí, Raman Khanna, Zoë Kopp

Category Research

Concept Stigmatizing Language

Concept Behavioral Alert

Concept Clinical Documentation

Concept Hospitalized Patient

Concept Multivariable Regression

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Adrià Jiménez Bacardí

Track Communication

Keywords

stigmatizing language

behavioral alerts

hospital medicine

patient chart

psychiatric diagnosis

healthcare bias

Medicare

Medicaid

Hispanic/Latino ethnicity

discrimination in care

Stigmatizing Language

Behavioral Alert

Clinical Documentation

Hospitalized Patient

Multivariable Regression