Association of Race/Ethnicity With Emergency Department Destination of Emergency Medical Services Transport
Association of Race/Ethnicity With Emergency Department Destination of Emergency Medical Services Transport
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DOI：
10.1001/jamanetworkopen.2019.10816
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发表时间：
2019-09-01
影响因子：
13.8
通讯作者：
Feldman, James
中科院分区：
文献类型：
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作者：
Hanchate, Amresh D.;Paasche-Orlow, Michael K.;Feldman, James
国家研究的证据表明，少数种族/族裔接受护理的医院存在系统性差异，大多数护理是在一小部分医院获得的。为了根据患者种族/民族检查急诊科（艾德）急诊医疗服务（EMS）运输目的地的模式，并比较通过EMS运输的患者和不使用EMS的患者之间的模式。设计、设置和参与者这项美国EMS和ED的队列研究使用了2006年1月1日的医疗保险索赔数据。到2012年12月31日入选者年龄在66岁或以上的连续收费服务医疗保险覆盖范围（N = 864 750）被选为样本。使用具有相当数量（> 10）西班牙裔、非西班牙裔黑人和非西班牙裔白色受试者的邮政编码来比较不同种族/民族亚组的EMS使用情况。获得了所有艾德访视（使用和不使用EMS）的数据。数据分析时间为2018年12月18日至2019年7月7日。主要结局和指标主要结局指标为EMS运输目的地是否是白色患者中最常见的艾德目的地（参考艾德）。次要结果是（1）是否艾德的目的地是一个安全网医院和（2）EMS运输的距离从艾德destination.Results研究队列包括864 750名医疗保险参保者从4175选定的邮政编码谁有458 701艾德访问使用EMS运输。在这些EMS转运的登记者中，26.1%（127 555）年龄小于75岁，大多数是女性（302 430 [ 66.8%]）。总体而言，转运至参比艾德的白色患者比例为61.3%（95% CI，61.0%至61.7%）;黑人入组者（差异为-5.3%; 95% CI，-6.0%至-4.6%）和西班牙裔入组者（差异为-2.5%; 95% CI，-3.2%至-1.7%）的该比例较低。在高危急性疾病患者中发现了类似的模式;转移到参考艾德的比例为61.5%（95% CI，60.7%至62.2%），而这一比例在白色注册者中较低（差异为-6.7%; 95% CI，-8.3%至-5.0%）和西班牙裔入组者（差异为-2.6%; 95% CI，-4.5%至-0.7%）。在美国主要城市，观察到艾德目的地的黑人-白人不一致性较大（-9.3%; 95% CI，-10.9%至-7.7%）。与白人患者相比，黑人和西班牙裔患者更有可能被送往安全网艾德;在白色登记者中，送往安全网艾德的比例（18.5%; 95%CI，18.1%至18.7%）低于黑人入学者（差异2.7%; 95% CI，2.2%至3.2%）和西班牙裔入组者（差异1.9%; 95% CI，1.3%至2.4%）。非EMS转运的艾德访视的一致率在统计学上显著低于EMS转运的艾德访视;白色入组者的一致率为52.9%（95% CI，52.1%至53.6%）高于黑人登记者（差异为-4.8%; 95% CI，-6.4%至-3.3%）和西班牙裔入组者（差异为-3.0%; 95%CI，-4.7%至-1.3%）。结论和相关性本研究发现，使用EMS运输的患者在艾德目的地的种族/民族差异，黑人和西班牙裔患者比居住在同一地区的白色患者更容易被送往安全网医院艾德。
IMPORTANCE Evidence from national studies indicates systematic differences in hospitals in which racial/ethnic minorities receive care, with most care obtained in a small proportion of hospitals. Little is known about the source of these differences.OBJECTIVES To examine the patterns of emergency department (ED) destination of emergency medical services (EMS) transport according to patient race/ethnicity, and to compare the patterns between those transported by EMS and those who did not use EMS.DESIGN, SETTING, AND PARTICIPANTS This cohort study of US EMS and EDs used Medicare claims data from January 1, 2006, to December 31, 2012. Enrollees aged 66 years or older with continuous fee-for-service Medicare coverage (N = 864 750) were selected for the sample. Zip codes with a sizable count (> 10) of Hispanic, non-Hispanic black, and non-Hispanic white enrollees were used for comparison of EMS use across racial/ethnic subgroups. Data on all ED visits, with and without EMS use, were obtained. Data analysis was performed from December 18, 2018, to July 7, 2019.MAIN OUTCOMES AND MEASURES The main outcome measure was whether an EMS transport destination was the most frequent ED destination among white patients (reference ED). The secondary outcomes were (1) whether the ED destination was a safety-net hospital and (2) the distance of EMS transport from the ED destination.RESULTS The study cohort comprised 864 750 Medicare enrollees from 4175 selected zip codes who had 458 701 ED visits using EMS transport. Of these EMS-transported enrollees, 26.1%(127 555) were younger than 75 years, and most were women (302 430 [ 66.8%]). Overall, the proportion of white patients transported to the reference ED was 61.3%(95% CI, 61.0% to 61.7%); this rate was lower among black enrollees (difference of -5.3%; 95% CI, -6.0% to -4.6%) and Hispanic enrollees (difference of -2.5%; 95% CI, -3.2% to -1.7%). A similar pattern was found among patients with high-risk acute conditions; the proportion transported to the reference ED was 61.5%(95% CI, 60.7% to 62.2%) among white enrollees, whereas this proportion was lower among black enrollees (difference of -6.7%; 95% CI, -8.3% to -5.0%) and Hispanic enrollees (difference of -2.6%; 95% CI, -4.5% to -0.7%). In major US cities, a larger black-white discordance in ED destinationwas observed (-9.3%; 95% CI, -10.9% to -7.7%). Black and Hispanic patients were more likely to be transported to a safety-net ED compared with their white counterparts; the proportion transported to a safety-net ED among white enrollees (18.5%; 95% CI, 18.1% to 18.7%) was lower compared with that among black enrollees (difference of 2.7%; 95% CI, 2.2% to 3.2%) and Hispanic enrollees (difference of 1.9%; 95% CI, 1.3% to 2.4%). Concordance rates of non-EMS-transported ED visits were statistically significantly lower than for EMS-transported ED visits; the concordance rate among white enrollees of 52.9% (95% CI, 52.1% to 53.6%) was higher compared with that among black enrollees (difference of -4.8%; 95% CI, -6.4% to -3.3%) and Hispanic enrollees (difference of -3.0%; 95% CI, -4.7% to -1.3%).CONCLUSIONS AND RELEVANCE This study found race/ethnicity variation in ED destination for patients using EMS transport, with black and Hispanic patients more likely to be transported to a safety-net hospital ED compared with white patients living in the same zip code.