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

项目摘要 因为医院在缺乏能力的情况下会转移急诊科的病人， 为了确保获得紧急护理的机会是公平的，至关重要的是，这些转移不因种族，民族或付款人而异。 这一目标载于《紧急医疗和劳动法》（EMTALA），该法要求医疗保险- 参与医院为所有患者提供紧急护理，无论种族，民族或保险状况如何。 然而，急诊室的转移存在差异。这项研究的假设是， 差异反映了结构性种族主义和歧视;医院可能会通过以下方式规避EMTALA的目标： 利用该法律的“非歧视条款”，要求具有专业能力的医院 如果他们有能力，接受EMTALA转移。该项目将审查非歧视原则的战略使用情况， （1）衡量少数族裔与非白色族裔在艾德住院时间方面的差异; 西班牙裔转移患者，并确定住院时间的差异是否与 患者结局;（2）评估少数民族与白色非西班牙裔、需要专门治疗的艾德患者 护理不太可能转移到同一所有制系统内的医院;（3）确定是否 与非西班牙裔白色患者相比，少数艾德患者更有可能被转移到安全的 网医院所有分析均将按人种/种族和按人种/种族检查患者的差异， 同一个付款人。拟议的研究是创新的，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，并允许我们解开种族/民族与 付款人。此外，它使我们不仅可以检查少数民族是否更不可能经历艾德 转移比白色非西班牙裔患者，而且是否有差异，在时间的艾德转移 以及少数族裔患者是否比非西班牙裔的白色人更有可能被转移到不同的医院 患者拟议的项目是重要的，因为这些见解可以用来改善政策， 证据表明，改善艾德转移的公平性是否最好通过颁布法规来解决， 促进非不同的急诊室转移，或扩大这些转移的协议化。

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.