Impact of EMTALA on Access to and Quality of Emergency Care

EMTALA 对紧急护理的获取和质量的影响

• 批准号: 10651744
• 负责人: Seth Seabury
• 金额: $ 39.3万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10651744
• 关键词: Impact; EMTALA; Access; Quality; Emergency

Project Summary Before the 1986 enactment of the Emergency Medical Treatment and Labor Act (EMTALA), emergency departments (EDs) could legally turn away patients with emergency conditions based upon condition or ability to pay. EMTALA imposed a duty to treat, requiring that all patients presenting to an ED receive a timely medical screening evaluation, stabilization, and transfer if specialized stabilizing services are needed, regardless of condition or ability to pay. Hospitals are required to accept transfer of patients from other EDs if the receiving facility has specialized services required to stabilize their condition. Compliance with EMTALA is a condition of Medicare participation, and failure to comply with EMTALA can result in termination of a hospital’s Medicare provider agreement, a serious consequence that can result in hospital closure. EMTALA is actively enforced with a quarter of U.S. hospitals cited for violating the law within the past decade. Faced with an EMTALA citation, hospitals have two principal options to improve EMTALA compliance. First, they could enhance policies, procedures and service availability - improving access to and quality of care. Alternatively, hospitals could eliminate service lines reducing both responsibilities under EMTALA as well as access to care for the population served by the hospital. Indirect evidence suggests that some hospitals have responded to EMTALA enforcement in ways that might paradoxically reduce access to or quality of emergency care, likely exacerbating disparities. However, no publications directly evaluate how EMTALA enforcement impacts access to or the quality of emergency care. Nor is it known how hospitals responded to EMTALA enforcement in the wake of the COVID- 19 pandemic. To address this knowledge gap, we propose to build on an existing dataset and create a file including all EMTALA citations from 2011-present and link with data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD), the State Inpatient Databases (SID), Hospital Compare data to complete a study with the following Aims: (1) To evaluate whether access to emergency care improves following EMTALA citation (2) To assess whether disparities in access to care change in response to EMTALA citation, (3) To determine if quality of emergency care changes in response to EMTALA citations, (4) To quantify whether these effects varied during the COVID-19 pandemic, and finally (5) To characterize corrective action plans proposed by hospitals in response to citation to determine which actions and operational changes are associated with change in access to or quality of care. Understanding whether EMTALA enforcement impacts access to and quality of emergency care, and which corrective action plans serve as likely mechanisms for observed changes will be imperative to informing future efforts to enhance or improve the statute to ensure access to quality emergency care for historically underserved populations, and in particular low-income and minority groups, all AHRQ priority populations.

项目概要 在 1986 年颁布《紧急医疗和劳动法》(EMTALA) 之前，紧急医疗 部门（ED）可以根据病情或能力合法拒绝患有紧急情况的患者 支付。 EMTALA 规定了治疗义务，要求所有到急诊室就诊的患者都必须及时接受医疗 如果需要专门的稳定服务，则进行筛选评估、稳定和转移，无论情况如何 条件或支付能力。医院必须接受从其他急诊室转来的患者，如果 设施提供稳定其状况所需的专门服务。遵守 EMTALA 的条件是 参与 Medicare 以及不遵守 EMTALA 可能会导致医院的 Medicare 终止 提供者协议，严重后果可能导致医院关闭。 EMTALA 得到积极执行 四分之一的美国医院在过去十年内因违反该法律而被指。面对 EMTALA 的罚单， 医院有两种主要选择来提高 EMTALA 合规性。首先，他们可以加强政策， 程序和服务可用性 - 改善护理的可及性和质量。或者，医院可以 消除服务线，减少 EMTALA 下的责任以及民众获得护理的机会 由医院服务。间接证据表明一些医院已对 EMTAL 执法做出回应 其方式可能会矛盾地减少获得紧急护理的机会或质量，并可能加剧差距。 然而，没有出版物直接评估 EMTAL 执法如何影响信息的获取或质量 紧急护理。也不知道在新冠肺炎疫情发生后，医院如何应对 EMTALA 执法。 19 流行病。为了解决这一知识差距，我们建议在现有数据集的基础上构建并创建一个文件 包括 2011 年至今的所有 EMTALA 引文，并与医疗保健成本和利用率的数据链接 项目 (HCUP) 州急诊科数据库 (SEDD)、州住院数据库 (SID)、医院 比较数据以完成研究，其目的如下：(1) 评估是否获得紧急护理 EMTALA 引用后有所改善 (2) 评估获得护理的差异是否会因 EMTALA 引文，(3) 确定紧急护理质量是否因 EMTALA 引文而发生变化，(4) 量化这些影响在 COVID-19 大流行期间是否有所变化，最后 (5) 表征 医院根据传票提出的纠正行动计划，以确定哪些行动和操作 变化与护理获取或质量的变化相关。了解是否存在 EMTALA 执法会影响紧急护理的获取和质量，以及哪些纠正行动计划可能发挥作用 观察到的变化的机制对于为未来加强或改进法规的努力提供信息至关重要 确保历史上服务不足的人群，特别是低收入人群获得优质的紧急护理 和少数群体、所有 AHRQ 优先人群。