September 06, 2019
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ED destination of EMS transport varies by race

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The ED to which emergency medical services transport a patient depends on the patient’s race/ethnicity, according to study findings published in JAMA Network Open. For example, black and Hispanic patients were less likely to be transported to the most frequent ED destination for white patients residing in the same zip code, researchers said.

The study follows previous findings that identified disparities of care and outcomes in hospitals that treat more patients who are racial/ethnic minorities compared with hospitals that treat more white patients, the authors noted.

“Examination of ED destinations of EMS-transported patients provides a potential pathway of differences in hospital destination by race/ethnicity,” Amresh D. Hanchate, PhD, associate professor of medicine in the section of general internal medicine at Boston University School of Medicine, and colleagues wrote.

Researchers included data from Medicare enrollees aged 66 years and older for up to 3 years or until their death between Jan. 1, 2006, and Dec. 31, 2012. Zip codes included in the study had at five EMS transport claims for each racial/ethnic group included in the study: Hispanic, black, white and other. ED data from patients who were not brought there through EMS services were also examined in the study.

Emergency Room Sign 
The ED to which emergency medical services transport a patient depends on the patient’s race/ethnicity, according to study findings published in JAMA Network Open. For example, black and Hispanic patients were less likely to be transported to the most frequent ED destination for white patients residing in the same zip code, researchers said.
Source: Adobe Stock

A total of 864,750 participants from 4,175 zip codes were included in the study, accounting for 458,701 ED visits that used EMS transport.

Among the study cohort, 61.3% (95% CI, 61-61.7) of white patients were transferred to the reference ED, or the most frequent ED destination among white patients in the zip code. The rate of patients sent to the reference ED was lower among black (difference of 5.3%; 95% CI, 6 to 4.6) and Hispanic (difference of 2.5%; 95% CI, 3.2 to 1.7) patients. A similar pattern was identified in patients with high-risk acute conditions.

Researchers noted a greater difference in ED destination between black and white patients within major cities in the United States (9.3%; 95% CI, 10.9 to 7.7).

The rate of white patients transported to safety-net hospitals (18.5%; 95% CI, 18.1-18.7) was lower than the rate of black (difference = 2.7%; 95% CI, 2.2-3.2) and Hispanic (difference = 1.9%; 95% CI, 1.3-2.4) patients taken to safety-net hospitals.

Compared to ED visits with EMS transport, walk-in ED visits had a lower rate of concordance with the reference ED in a zip code. The rate of white walk-in patients who visited the reference ED within their zip code was 52.9% (95% CI, 52.1-53.6), with lower rates in black (difference of 4.8%; 95% CI,6.4 to 3.3) and Hispanic patients (difference of 3%; 95% CI, 4.7 to 1.3).

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The similar patterns in ED destination between EMS transported patients and walk-ins suggests that patient or family choice could affect ED destination, the authors noted.

“Future research is needed to understand the reasons for the divergence in ED destination by EMS transport and the extent to which this divergence may be associated with patient outcomes; the results of such research may inform the development of better EMS protocols,” Hanchate and colleagues wrote. – by Erin Michael

Disclosures: Hanchate reported receiving grants from the NIH during the conduct of the study. Please see study for all other authors’ relevant financial disclosures.