Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2025
Patient Disability Status and the Use of Stigmatizing Language in Clinical Notes During Hospital Admission for Birth.
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Harkins Sarah E, Hulchafo Ismael I, Scroggins Jihye Kim, Walsh Caroline, Didier Meghan, Topaz Maxim, Barcelona Veronica
Аннотация
OBJECTIVE: To examine the association between patient disability status and use of stigmatizing language in clinical notes from the hospital admission for birth.
DESIGN: Cross-sectional study of electronic health record data.
SETTING: Two urban hospitals in the northeastern United States.
PARTICIPANTS: Patients at more than 20 weeks gestation admitted for birth from 2017 to 2019 (N = 19,094).
METHODS: We used a natural language processing algorithm to identify categories of stigmatizing language used in free-text clinical notes (N = 211,841 unique clinical notes). We employed multivariable logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for each stigmatizing language category by disability status, which we determined by ICD-10 (International Classification of Diseases, 10th revision) codes.
RESULTS: Approximately 3% of patient records (n = 550) included ICD-10 codes for disability. Clinicians were more likely to use stigmatizing language for patients with disabilities compared with patients without disabilities (aOR = 1.75, 95% CI = [1.47, 2.09]). For patients with disabilities compared with patients without disabilities, clinicians were also more likely to use stigmatizing language in the difficult patient category (aOR = 1.96, 95% CI = [1.65, 2.33]) and the unilateral/authoritarian decisions category (aOR = 1.27, 95% CI = [1.06, 1.53]). We found no significant differences for the marginalized language/identities category by patient disability status (aOR = 1.19, 95% CI = [0.87, 1.62]).
CONCLUSION: The use of stigmatizing language in birth hospitalization notes differed by patient disability status. Stigmatizing language should be used as a marker of bias and an opportunity for clinicians to reflect on their thoughts, words, and actions. Patient-centered documentation and care practices are needed to improve perinatal health for all.
DESIGN: Cross-sectional study of electronic health record data.
SETTING: Two urban hospitals in the northeastern United States.
PARTICIPANTS: Patients at more than 20 weeks gestation admitted for birth from 2017 to 2019 (N = 19,094).
METHODS: We used a natural language processing algorithm to identify categories of stigmatizing language used in free-text clinical notes (N = 211,841 unique clinical notes). We employed multivariable logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for each stigmatizing language category by disability status, which we determined by ICD-10 (International Classification of Diseases, 10th revision) codes.
RESULTS: Approximately 3% of patient records (n = 550) included ICD-10 codes for disability. Clinicians were more likely to use stigmatizing language for patients with disabilities compared with patients without disabilities (aOR = 1.75, 95% CI = [1.47, 2.09]). For patients with disabilities compared with patients without disabilities, clinicians were also more likely to use stigmatizing language in the difficult patient category (aOR = 1.96, 95% CI = [1.65, 2.33]) and the unilateral/authoritarian decisions category (aOR = 1.27, 95% CI = [1.06, 1.53]). We found no significant differences for the marginalized language/identities category by patient disability status (aOR = 1.19, 95% CI = [0.87, 1.62]).
CONCLUSION: The use of stigmatizing language in birth hospitalization notes differed by patient disability status. Stigmatizing language should be used as a marker of bias and an opportunity for clinicians to reflect on their thoughts, words, and actions. Patient-centered documentation and care practices are needed to improve perinatal health for all.