Overview of EEDI

A retrospective observational study using secondary data on ED admission between 2006 and 2012

The aim:

To investigate whether clinically important ethnic inequities between Māori and non-Māori exist within EDs across Aotearoa New Zealand.

The EEDI study hypothesises that:

  1. There are inequities in ED practice and outcomes between Māori and non-Māori within NZ.
  2. Any inequities between Māori and non-Māori are unlikely to be fully explained by pre-admission / patient demographic variables.
  3. Any inequities in ED markers of care between Māori and non-Māori are likely to contribute to differences in clinically important outcomes including mortality.

Research objectives investigated ED inequities within:

  1. Patient-centred markers of care (e.g. whether patients waited to be seen by a physician, the time from presentation to ED and assessment by an ED physician, readmission or re-presentation post-ED visit).
  2. System-centred markers of care (e.g. length of stay in the ED, admission to hospital and indicators of access block as a marker of overcrowding).
  3. Mortality (e.g. within ED or within 10 days of ED assessment, 30 days post discharge).

Approach based on Kaupapa Māori Research (KMR) positioning

The EEDI project was undertaken with a Kaupapa Māori Research (KMR) positioning.

KMR places Māori at the centre of enquiry in order to make a positive difference to Māori communities. The EEDI project reflects KMR through a range of practices:

  • Māori-led research expertise that maintains Māori control of the research process.
  • Investigation of Māori areas of health with potential to transform Māori health gain.
  • Māori:non-Māori comparison consistent with the Indigenous rights of Māori.
  • Maximisation of statistical power to quantitatively examine Māori:non- Māori inequities.
  • A conceptual framework that incorporates a structural determinants approach to critique issues of power, racism and privilege.

Conceptual framework

The diagram below illustrates the basic conceptual framework for EEDI that highlights high Māori ED use and the complex ED environment as precursors for potential provider bias leading to ethnic inequities in ED outcomes.

Ethical approval

Ethical approval was obtained from the NZ Health and Disability Ethics Committee (HDEC 17/NTB/185).