1. Racial and ethnic disparities in emergency department transfers to public hospitals
- Author
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Hsuan, Charleen, Vanness, David J., Zebrowski, Alexis, Carr, Brendan G., Norton, Edward C., Buckler, David G., Wang, Yinan, Leslie, Douglas L., Dunham, Eleanor F., and Rogowski, Jeannette A.
- Subjects
Medical care -- Utilization ,Medical research -- Surveys ,Medicine, Experimental -- Surveys ,Hospitals -- Emergency service ,Emergency medicine -- Surveys ,Hospital patients -- Surveys ,Hospitals, Public -- Surveys ,Business ,Health care industry ,Emergency Medical Treatment and Active Labor Act of 1985 - Abstract
Objective: To examine racial/ethnic differences in emergency department (ED) transfers to public hospitals and factors explaining these differences. Data Sources and Study Setting: ED and inpatient data from the Healthcare Cost and Utilization Project for Florida (2010-2019); American Hospital Association Annual Survey (2009-2018). Study Design: Logistic regression examined race/ethnicity and payer on the likelihood of transfer to a public hospital among transferred ED patients. The base model was controlled for patient and hospital characteristics and year fixed effects. Models II and III added urbanicity and hospital referral region (HRR), respectively. Model IV used hospital fixed effects, which compares patients within the same hospital. Models V and VI stratified Model IV by payer and condition, respectively. Conditions were classified as emergency care sensitive conditions (ECSCs), where transfer is protocolized, and non-ECSCs. We reported marginal effects at the means. Data Collection/Extraction Methods: We examined 1,265,588 adult ED patients transferred from 187 hospitals. Principal Findings: Black patients were more likely to be transferred to public hospitals compared with White patients in all models except ECSC patients within the same initial hospital (except trauma). Black patients were 0.5-1.3 percentage points (pp) more likely to be transferred to public hospitals than White patients in the same hospital with the same payer. In the base model, Hispanic patients were more likely to be transferred to public hospitals compared with White patients, but this difference reversed after controlling for HRR. Hispanic patients were - 0.6 pp to -1.2 pp less likely to be transferred to public hospitals than White patients in the same hospital with the same payer. Conclusions: Large population-level differences in whether ED patients of different races/ethnicities were transferred to public hospitals were largely explained by hospital market and the initial hospital, suggesting that they may play a larger role in explaining differences in transfer to public hospitals, compared with other external factors. KEYWORDS disparities, emergency departments, public hospital, race and ethnicity, transfers, 1 | INTRODUCTION Access to hospital-based emergency care is an important population health metric, (1) but it is not equitable. Emergency department (ED) capability and capacity vary geographically, (2-4) with [...]
- Published
- 2024
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