Clinical Scorecard: Adverse Characterizations of Sickle Cell Disease Patients in Electronic Health Records

At a Glance

Key Highlights

• Clinician biases based on race, chronic pain, and opioid use contribute to negative descriptors in electronic health records for patients with SCD.
• Patients with SCD experience compounded stigma due to intersecting identities including minoritized race and chronic disease status.
• Negative descriptors in clinical notes are associated with less aggressive pain management and poorer health outcomes.

Guideline-Based Recommendations

Diagnosis

• Use comprehensive ICD-10 coding to identify SCD and intersecting conditions such as chronic pain and opioid use disorder.

Management

• Recognize and mitigate clinician biases to improve pain management and equitable care for patients with SCD.
• Avoid biased language in clinical documentation to prevent negative impacts on treatment decisions.

Monitoring & Follow-up

• Monitor clinical notes for presence of negative descriptors that may reflect implicit bias.
• Use natural language processing tools to identify and address biased documentation.

Risks

• Risk of undertreatment of pain due to biased perceptions of patients with SCD.
• Increased likelihood of discrimination and stigmatization in healthcare settings.

Patient & Prescribing Data

Patients with SCD, predominantly Black individuals with chronic pain and opioid use considerations

Biases contribute to fewer opioid prescriptions for pain management despite high pain burden in SCD patients.

Clinical Best Practices

• Implement training to reduce implicit biases among healthcare providers caring for patients with SCD.
• Use objective pain assessment tools to guide opioid prescribing and pain management.
• Ensure equitable documentation practices avoiding stigmatizing language in electronic health records.

References

• STROBE Reporting Guideline
• ICD-10 Coding for SCD and Related Conditions