EXPRESS: Racial Bias in Pain Measurement Frequency in ICUs and Its Impact on Early Readmission

A significant portion of hospitalizations result in readmissions, many of which are preventable. Additionally, over a quarter of admissions necessitate intensive care unit (ICU) stays. These trends impose significant strain on healthcare systems, leading to penalties and reduced reimbursements for healthcare facilities. Consequently, reducing readmissions stands as a critical priority for healthcare institutions, with a specific focus on ICU processes and procedures. While some healthcare processes, such as vital sign monitoring, are consistent across patient cohorts, disparities in pain management have been well-documented. Existing research predominantly explores biases in outpatient settings, particularly in the underestimation and undertreatment of pain for Black patients. However, these biases can extend to the frequency of pain measurements in ICUs, where continuous monitoring plays a pivotal role in patient care. This study investigates disparities in pain measurement frequencies in ICUs for patients of different races and their impact on early readmission rates. Utilizing a dataset of ICU stays from a major U.S. healthcare institution, we employ mediation analysis with instrumental variables by performing a 2-step mediation analysis using IV-Probit estimator to answer these research questions. Our findings reveal that the frequency of pain measurements in ICU stays partially mediate the relationship between a patient's race and the probability of early readmission. Specifically, Black patients receive fewer pain measurements during their ICU stays compared to White patients, increasing their likelihood of 30-day readmission. This study represents the first to demonstrate that bias in pain management extends to the frequency of pain measurements in intensive care settings, shedding light on a critical aspect of healthcare disparities and their impact on readmission rates. The implications of our findings span healthcare practice, operations, and the growing body of literature on healthcare equity, offering valuable insights into addressing these disparities.