Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts' ambulance diversion ban.
Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts' ambulance diversion ban.
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DOI：
10.1186/s12913-022-08358-8
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发表时间：
2022-08-03
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
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救护车分流对可能分流的患者，特别是少数种族/民族患者的影响在很大程度上是未知的。将马萨诸塞州2009年的救护车分流禁令作为一项自然实验，我们检查了该禁令是否与不同种族/民族的急诊医疗服务（EMS）患者被运送到同一急诊科（艾德）的一致性增加有关。我们获得了66岁及以上参保者的医疗保险服务费索赔记录（2007-2012年）。我们将国家按患者邮政编码分层，并确定了具有相当大的（非西班牙裔）白色、（非西班牙裔）黑人和西班牙裔入组者的邮政编码。对于来自马萨诸塞州和18个选定的比较州的所有不同邮政编码的登记者的分层随机样本，我们确定了EMS运输到ED。在每个邮政编码中，我们确定了白色EMS运输患者（“参考艾德”）最常见的艾德目的地。我们的主要结局是患者EMS转运至参考艾德的二分指标，次要结局是转运至服务于低收入患者的艾德（“安全网艾德”）。使用差异中的差异回归规范，我们将马萨诸塞州每个结果的禁令前后变化与比较州的相应变化进行了对比。来自3331个邮政编码的744，791名参与者的研究队列经历了361，006次EMS运输。基线时，马萨诸塞州和对照州的白色患者转运至参考艾德的比例（67.2和60.9%）高于黑人（43.6和46.2%）和西班牙裔（62.5和52.7%）患者。马萨诸塞州的救护车分流禁令与白色患者（-2.7个百分点; 95%CI，-4.5至-1.0）和黑人患者（-4.1个百分点; 95%CI，-6.2至-1.9）中转运至参考艾德的比例下降相关，而西班牙裔患者中无变化。该禁令与西班牙裔患者转移到安全网艾德的可能性增加（3.0个百分点，95% CI，0.3至5.7）和白色患者的可能性降低（1.2个百分点，95% CI，-2.3至-0.2）相关。马萨诸塞州的救护车分流禁令与白色和黑色EMS患者被运送到白色患者最常见的艾德目的地的比例减少有关，突出了EMS运输目的地的非邻近因素的作用。在线版本包含补充材料，可通过10.1186/s12913-022-08358-8获得。
The impact of ambulance diversion on potentially diverted patients, particularly racial/ethnic minority patients, is largely unknown. Treating Massachusetts’ 2009 ambulance diversion ban as a natural experiment, we examined if the ban was associated with increased concordance in Emergency Medical Services (EMS) patients of different race/ethnicity being transported to the same emergency department (ED). We obtained Medicare Fee for Service claims records (2007–2012) for enrollees aged 66 and older. We stratified the country into patient zip codes and identified zip codes with sizable (non-Hispanic) White, (non-Hispanic) Black and Hispanic enrollees. For a stratified random sample of enrollees from all diverse zip codes in Massachusetts and 18 selected comparison states, we identified EMS transports to an ED. In each zip code, we identified the most frequent ED destination of White EMS-transported patients (“reference ED”). Our main outcome was a dichotomous indicator of patient EMS transport to the reference ED, and secondary outcome was transport to an ED serving lower-income patients (“safety-net ED”). Using a difference-in-differences regression specification, we contrasted the pre- to post-ban changes in each outcome in Massachusetts with the corresponding change in the comparison states. Our study cohort of 744,791 enrollees from 3331 zip codes experienced 361,006 EMS transports. At baseline, the proportion transported to the reference ED was higher among White patients in Massachusetts and comparison states (67.2 and 60.9%) than among Black (43.6 and 46.2%) and Hispanic (62.5 and 52.7%) patients. Massachusetts ambulance diversion ban was associated with a decreased proportion transported to the reference ED among White (− 2.7 percentage point; 95% CI, − 4.5 to − 1.0) and Black (− 4.1 percentage point; 95% CI, − 6.2 to − 1.9) patients and no change among Hispanic patients. The ban was associated with an increase in likelihood of transport to a safety-net ED among Hispanic patients (3.0 percentage points, 95% CI, 0.3 to 5.7) and a decreased likelihood among White patients (1.2 percentage points, 95% CI, − 2.3 to − 0.2). Massachusetts ambulance diversion ban was associated with a reduction in the proportion of White and Black EMS patients being transported to the most frequent ED destination for White patients, highlighting the role of non-proximity factors in EMS transport destination. The online version contains supplementary material available at 10.1186/s12913-022-08358-8.
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影响因子：
13.8
作者：
Hanchate, Amresh D.;Paasche-Orlow, Michael K.;Feldman, James
通讯作者：
Feldman, James
DOI：
10.1086/677756
发表时间：
2015-02-01
期刊：
The journal of political economy
影响因子：
--
作者：
Doyle J;Graves J;Gruber J;Kleiner S
通讯作者：
Kleiner S
影响因子：
9.7
作者：
Jha, Ashish K.;Orav, E. John;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.
影响因子：
--
作者：
Jha, Ashish K.;Orav, E. John;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.
影响因子：
9.7
作者：
Jha, Ashish K.;Orav, E. John;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.