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: 10522991
• 负责人: Seth Seabury
• 金额: $ 40万
• 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/10522991
• 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.

项目摘要 在1986年颁布《紧急医疗和劳动法》（EMTALA）之前， 急诊科（ED）可以根据病情或能力合法地拒绝急诊病人 支付. EMTALA规定了治疗责任，要求所有到艾德就诊的患者及时接受医疗检查。 筛选评估，稳定和转移，如果需要专门的稳定服务，无论 条件或支付能力。医院须接受其他急症室转介的病人， 设施有稳定他们状况所需的专门服务。遵守EMTALA是一个条件， 参与Medicare，以及未能遵守EMTALA可能导致医院的Medicare终止 供应商协议，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中因违反法律而被引用。面对EMTALA的引用， 医院有两个主要的选择来提高EMTALA的依从性。首先，它们可以加强政策， 程序和服务的提供-改善获得护理的机会和质量。另外，医院可以 取消服务项目，减少EMTALA规定的责任以及人口获得护理的机会 由医院提供。间接证据表明，一些医院对EMTALA的执行作出了回应， 这可能会矛盾地减少获得紧急护理的机会或质量，可能会加剧不平等。 然而，没有出版物直接评估EMTALA的执行如何影响获得或质量， 紧急护理。也不知道医院在COVID-19之后如何应对EMTALA的执法- 19大流行病。为了解决这一知识缺口，我们建议在现有数据集的基础上创建一个文件 包括2011年至今的所有EMTALA引文，并与医疗保健成本和利用数据相关联 项目（HCUP）州急诊部门数据库（SEDD）、州住院患者数据库（SID）、医院 比较数据以完成以下目的的研究：（1）评估是否可以获得紧急护理 （2）评估获得护理的差异是否会因以下原因而改变： EMTALA引文，（3）确定急诊护理质量是否因EMTALA引文而发生变化，（4） 量化这些影响在COVID-19大流行期间是否发生变化，最后（5）描述 医院针对引文提出的纠正行动计划，以确定哪些行动和操作 变化与获得护理或护理质量的变化相关。了解EMTALA是否 执法影响获得紧急护理和质量，以及哪些纠正行动计划可能 观察到的变化的机制对于为今后加强或改进规约的努力提供信息至关重要 确保历史上得不到充分服务的人口，特别是低收入人口获得高质量的紧急护理 和少数群体，所有AHRQ优先人口。