Racial and ethnic disparities in emergency department transfers to public hospitals.

Autor: Hsuan C; Department of Health Policy & Administration, Pennsylvania State University, State College, Pennsylvania, USA., Vanness DJ; Department of Health Policy & Administration, Pennsylvania State University, State College, Pennsylvania, USA., Zebrowski A; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Carr BG; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Norton EC; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.; Department of Economics, University of Michigan, Ann Arbor, Michigan, USA., Buckler DG; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA., Wang Y; Department of Health Policy & Administration, Pennsylvania State University, State College, Pennsylvania, USA., Leslie DL; Department of Public Health Sciences, College of Medicine, Pennsylvania State University, State College, Pennsylvania, USA., Dunham EF; Department of Emergency Medicine, College of Medicine, Pennsylvania State University, State College, Pennsylvania, USA., Rogowski JA; Department of Health Policy & Administration, Pennsylvania State University, State College, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Health services research [Health Serv Res] 2024 Apr; Vol. 59 (2), pp. e14276. Date of Electronic Publication: 2024 Jan 17.
DOI: 10.1111/1475-6773.14276
Abstrakt: 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.
(© 2024 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)
Databáze: MEDLINE
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