Racial Disparities in Emergency Department Length of Stay for Admitted Patients in the United States
Racial Disparities in Emergency Department Length of Stay for Admitted Patients in the United States
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DOI：
10.1111/j.1553-2712.2009.00381.x
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发表时间：
2009-05-01
影响因子：
4.4
通讯作者：
Hollander, Judd E.
中科院分区：
文献类型：
--
作者：
Pines, Jesse M.;Localio, A. Russell;Hollander, Judd E.
最近的研究表明，延长急诊（艾德）登机时间对结果的不利影响。作者试图检查美国各医院在住院患者的艾德住院时间（LOS）方面的种族差异，这可能作为数据集中实际住院时间不可用的登机时间的代表。具体来说，该研究估计了黑人与非黑人种族对住院患者LOS的院内和院内影响，作者研究了全国医院门诊医疗调查（NHAMCS; 2003-2005）中408个ED的14，516名重症监护室（ICU）和非ICU入院患者。主要结果是艾德LOS（分诊转移到住院床位）和LOS延长（> 6小时）的患者比例。将黑人与非黑人种族对LOS的影响进行分解，以区分同一医院患者之间的种族差异（医院内部分）和为黑人患者比例较高的医院之间在未调整的分析中，入住ICU病床的黑人患者（367分钟vs. 290分钟）和非ICU病床的黑人患者（397分钟vs. 345分钟）的艾德LOS显著更长。对于入住ICU病床，院内估计表明黑人艾德LOS> 6小时的风险更高（比值比[OR] = 1.42，95%置信区间[CI] = 1.01至2.01），而医院间差异不显著（黑人患者比例每增加10%，OR = 1.08，95% CI = 0.96 - 1.23）。相比之下，对于非ICU入院，院内种族差异并不显著（OR = 1.12，95%CI = 0.94 ~ 1.23），但医院间差异有统计学意义（OR = 1.13，95% CI = 1.04 - 1.22）/10%通过艾德入院的黑人患者与非黑人相比具有更长的艾德LOS，这表明美国医院可能存在种族差异。非ICU患者的差异可能是由于黑人医院的差异，黑人比例较高的医院等待时间较长。ICU患者的差异更好地解释为医院内的差异，在同一家医院，黑人的等待时间比非黑人长。然而，可能还有其他未测量的临床或社会经济因素可以解释这些结果。
Recent studies have demonstrated the adverse effects of prolonged emergency department (ED) boarding times on outcomes. The authors sought to examine racial disparities across U.S. hospitals in ED length of stay (LOS) for admitted patients, which may serve as a proxy for boarding time in data sets where the actual time of admission is unavailable. Specifically, the study estimated both the within- and among-hospital effects of black versus non-black race on LOS for admitted patients.The authors studied 14,516 intensive care unit (ICU) and non-ICU admissions in 408 EDs in the National Hospital Ambulatory Medical Care Survey (NHAMCS; 2003-2005). The main outcomes were ED LOS (triage to transfer to inpatient bed) and proportion of patients with prolonged LOS (> 6 hours). The effects of black versus non-black race on LOS were decomposed to distinguish racial disparities between patients at the same hospital (within-hospital component) and between hospitals that serve higher proportions of black patients (among-hospital component).In the unadjusted analyses, ED LOS was significantly longer for black patients admitted to ICU beds (367 minutes vs. 290 minutes) and non-ICU beds (397 minutes vs. 345 minutes). For admissions to ICU beds, the within-hospital estimates suggested that blacks were at higher risk for ED LOS of > 6 hours (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.01 to 2.01), while the among-hospital differences were not significant (OR = 1.08 for each 10% increase in the proportion of black patients, 95% CI = 0.96 to 1.23). By contrast, for non-ICU admissions, the within-hospital racial disparities were not significant (OR = 1.12, 95% CI = 0.94 to 1.23), but the among-hospital differences were significant (OR = 1.13, 95% CI = 1.04 to 1.22) per 10% point increase in the percentage of blacks admitted to a hospital.Black patients who are admitted to the hospital through the ED have longer ED LOS compared to non-blacks, indicating that racial disparities may exist across U.S. hospitals. The disparity for non-ICU patients might be accounted for by among-hospital differences, where hospitals with a higher proportion of blacks have longer waits. The disparity for ICU patients is better explained by within-hospital differences, where blacks have longer wait times than non-blacks in the same hospital. However, there may be additional unmeasured clinical or socioeconomic factors that explain these results.