摘要：Objectives. We explored characteristics of in-hospital care and treatment of immigrant patients to better understand the processes underlying ethnic disparities in patient safety. Methods. We conducted semistructured interviews with care providers regarding patient safety events involving immigrant patients in in-hospital medical care and treatment, for a total of 30 cases. Interviews were transcribed and qualitatively analyzed with a framework method. Results. Three key patterns were identified from the analysis. Patient safety events occur because of (1) inappropriate responses by health care providers to objective characteristics of immigrant patients, such as low Dutch language proficiency, lack of health insurance, or genetic conditions; (2) misunderstandings between patients and care providers because of differences in illness perceptions and expectations about care and treatment; and (3) inappropriate care because of providers' prejudices against or stereotypical ideas regarding immigrant patients. Conclusions. Our findings suggest that organizational and health professional practices contribute to the higher risk of patient safety events. Descriptive epidemiological research is needed to explore the impact of the 3 patterns on patient safety. Patient safety is generally seen as one of the most pressing health care challenges. Research in the United States has shown that between 44 000 and 98 000 Americans die in hospitals each year as a result of adverse events, which are defined as an injury caused by the medical management rather than the underlying disease. 1 , 2 A recent systematic review study showed that adverse events affect nearly 1 in 10 patients during hospital stays. 3 Several studies in the United States pointed to ethnic differences playing a role in patient safety, with patient safety events in hospitals occurring more often in the care for immigrant patients in comparison with US-born patients. 4 – 8 Chang et al. 7 found that Black patients were approximately 20% more likely than were White patients to experience a patient safety event. Flores and Ngui 5 systematically reviewed racial/ethnic disparities in pediatric patient safety and found higher rates of newborn birth trauma and infections attributable to negligent medical care. Little is known about the processes that contribute to ethnic disparities in in-hospital patient safety, as the potential contributions of organizational and individual care characteristics in the prevention of patient safety events involving immigrant patients have rarely been the subject of research. 9 There is, as Johnstone and Kanitsaki 9 put it, a paucity of literature addressing the critical relationship that exists between culture, language, and patient safety. A few studies indicate that language differences between physician and patient lead to a higher risk of incidents. 10 – 12 The use of family or friends as interpreters instead of professional interpreters may also lead to errors in medical interpretations, with potentially serious clinical consequences. 10 , 13 Apart from the above-mentioned studies, there is, to our knowledge, no research into different kinds of processes with regard to ethnic disparities in patient safety. Therefore, we explored different processes of in-hospital care and treatment of immigrant patients to better understand the processes underlying ethnic disparities in patient safety.
