Structural Racism and Discrimination in Emergency Department Transfers: Unintended Consequences of the Emergency Medical Treatment and Labor Act (EMTALA)

项目总结 因为医院在急诊科患者缺乏能力的时候就会转移，以确保 获得紧急护理的机会是公平的，但至关重要的是，这些转移不因种族、族裔或付款人而异。 这一目标被载入《紧急医疗和劳工法案》(EMTALA)，该法案要求医疗保险-- 参与的医院为所有患者提供紧急护理，不分种族、民族或保险状况。 然而，急诊科转院方面存在差异。拟议研究的假设是，这些 差异反映了结构性种族主义和歧视；医院可能通过以下方式绕过EMTALA的目标 利用该法律的“非歧视条款”，该条款要求具有专科能力的医院 如果EMTALA转账有能力，则接受转账。该项目将审查非歧视的战略使用 以下三个目标中的规定：(1)衡量少数族裔与非白人在ED逗留时间上的差异 西班牙裔转院患者，并确定住院时间的差异是否与 患者结局；(2)评估少数族裔与白人非西班牙裔ED患者是否需要专门的 医疗服务不太可能转移到同一所有制下的医院；以及(3)确定 与非西班牙裔白人患者相比，少数族裔ED患者更有可能被转移到安全的地方- Net医院。所有的分析将检查种族/民族和种族/民族的差异 同样的付款人。拟议的研究具有创新性，因为它确定了结构性种族主义和歧视 通过组织行为的变化，并允许我们区分种族/民族和 付款人。此外，它让我们不仅可以检查少数族裔是否不太可能经历ED 转院比白人非西班牙裔患者，还要看ED转院的时间是否有差异 少数族裔患者是否比非西班牙裔白人更有可能被转移到不同的医院 病人。拟议的项目意义重大，因为这些见解可以用来通过提供 证据表明，改善教育转移的公平性是否最好是通过颁布以下法规来解决 促进非完全不同的急诊科转院，或扩大这些转院的协议化。

PROJECT SUMMARY Because hospitals transfer emergency department patients when they lack capability, in order to ensure that access to emergency care is equitable, it is critical that these transfers do not vary by race, ethnicity, or payer. This goal is enshrined in the Emergency Medical Treatment and Labor Act (EMTALA), which requires Medicare- participating hospitals to provide emergency care to all patients, regardless of race, ethnicity, or insurance status. Yet disparities in emergency department transfers exist. The hypothesis of the proposed study is that these disparities reflect structural racism and discrimination; hospitals may circumvent the goals of EMTALA by leveraging the “nondiscrimination provision” of that law, which requires that hospitals with specialized capabilities accept EMTALA transfers if they have capacity. The project will examine strategic use of the nondiscrimination provision in the following three aims: (1) measure differences in ED length of stay for minority versus White non- Hispanic transfer patients, and determine whether differences in length of stay are associated with disparities in patient outcomes; (2) assess whether minority, versus White non-Hispanic, ED patients requiring specialized care are less likely to be transferred to hospitals within the same ownership system; and (3) determine whether minority ED patients, compared with White non-Hispanic patients, are more likely to be transferred to a safety- net hospital. All analyses will examine differences by race/ethnicity and by race/ethnicity for patients with the same payer. The proposed research is innovative because it identifies structural racism and discrimination through variations in organizational behavior, and permits us to disentangle differences by race/ethnicity versus payer. Furthermore, it allows us to examine not just whether minorities are less likely to experience an ED transfer than White non-Hispanic patients, but also whether there are differences in the timing of the ED transfer and whether minority patients are more likely to be transferred to different hospitals than White non-Hispanic patients. The proposed project is significant because these insights may be used to improve policy by providing evidence whether improving the equity of ED transfers might be best addressed by promulgating regulations to promote non-disparate emergency department transfers, or expanding protocolization of these transfers.