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Design of a prospective cohort study to assess ethnic inequalities in patient safety in hospital care using mixed methods

Floor van Rosse12*, Martine C de Bruijne2, Cordula Wagner23, Karien Stronks1 and Marie-Louise Essink-Bot1

Author affiliations

1 Department of Public Health, Academic Medical Center, Meibergdreef 9, Amsterdam, AZ 1105, The Netherlands

2 Department of Public and Occupational Health, VU University Medical Center (VUmc), EMGO Institute for Health and Care Research, Amsterdam, The Netherlands

3 NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands

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Citation and License

BMC Health Services Research 2012, 12:450  doi:10.1186/1472-6963-12-450

Published: 7 December 2012



While US studies show a higher risk of adverse events (AEs) for ethnic minorities in hospital care, in Europe ethnic inequalities in patient safety have never been analysed. Based on existing literature and exploratory research, our research group developed a conceptual model and empirical study to increase our understanding of the role ethnicity plays in patient safety. Our study is designed to (1) assess the risk of AEs for hospitalised patients of non-Western ethnic origin in comparison to ethnic Dutch patients; (2) analyse what patient-related determinants affect the risk of AEs; (3) explore the mechanisms of patient-provider interactions that may increase the risk of AEs; and (4) explore possible strategies to prevent inequalities in patient safety.


We are conducting a prospective mixed methods cohort study in four Dutch hospitals, which began in 2010 and is running until 2013. 2000 patients (1000 ethnic Dutch and 1000 of non-Western ethnic origin, ranging in age from 45-75 years) are included. Survey data are collected to capture patients’ explanatory variables (e.g., Dutch language proficiency, health literacy, socio-economic status (SES)-indicators, and religion) during hospital admission. After discharge, a two-stage medical record review using a standardized instrument is conducted by experienced reviewers to determine the incidence of AEs. Data will be analysed using multilevel multivariable logistic regression. Qualitative interviews with providers and patients will provide insight into the mechanisms of AEs and potential prevention strategies.


This study uses a robust study plan to quantify the risk difference of AEs between ethnic minority and Dutch patients in hospital care. In addition we are developing an in-depth description of the mechanisms of excess risk for some groups compared to others, while identifying opportunities for more equitable distributions of patient safety for all.