Shen Yu-Chu, Hsia Renee Y
Graduate School of Business and Public Policy, Naval Postgraduate School, Monterey, California, USA National Bureau of Economic Research, Cambridge, Massachusetts, USA.
Department of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California, USA.
BMJ Open. 2016 Mar 17;6(3):e010263. doi: 10.1136/bmjopen-2015-010263.
We investigated the association between crowding as measured by ambulance diversion and differences in access, treatment and outcomes between black and white patients.
Retrospective analysis.
We linked daily ambulance diversion logs from 26 California counties between 2001 and 2011 to Medicare patient records with acute myocardial infarction and categorised patients according to hours in diversion status for their nearest emergency departments on their day of admission: 0, <6, 6 to <12 and ≥ 12 h. We compared the amount of diversion time between hospitals serving high volume of black patients and other hospitals. We then use multivariate models to analyse changes in outcomes when patients faced different levels of diversion, and compared that change between black and white patients.
29,939 Medicare patients from 26 California counties between 2001 and 2011.
(1) Access to hospitals with cardiac technology; (2) treatment received; and (3) health outcomes (30-day, 90-day, and 1-year death and 30-day readmission).
Hospitals serving high volume of black patients spent more hours in diversion status compared with other hospitals. Patients faced with the highest level of diversion had the lowest probability of being admitted to hospitals with cardiac technology compared with those facing no diversion, by 4.4% for cardiac care intensive unit, and 3.4% for catheterisation laboratory and coronary artery bypass graft facilities. Patients experiencing increased diversion also had a 4.3% decreased likelihood of receiving catheterisation and 9.6% higher 1-year mortality.
Hospitals serving high volume of black patients are more likely to be on diversion, and diversion is associated with poorer access to cardiac technology, lower probability of receiving revascularisation and worse long-term mortality outcomes.
我们研究了用救护车分流来衡量的拥挤程度与黑人和白人患者在就医机会、治疗及治疗结果方面的差异之间的关联。
回顾性分析。
我们将2001年至2011年加利福尼亚州26个县的每日救护车分流日志与患有急性心肌梗死的医疗保险患者记录相链接，并根据入院当天患者在其最近急诊科的分流状态时长对患者进行分类：0小时、<6小时、6至<12小时以及≥12小时。我们比较了为大量黑人患者服务的医院与其他医院之间的分流时间量。然后我们使用多变量模型分析患者面临不同程度分流时治疗结果的变化，并比较黑人和白人患者之间的这种变化。
2001年至2011年来自加利福尼亚州26个县的29939名医疗保险患者。
（1）获得具备心脏治疗技术医院的就医机会；（2）接受的治疗；以及（3）健康结果（30天、90天和1年死亡率以及30天再入院率）。
与其他医院相比，为大量黑人患者服务的医院处于分流状态的时间更长。与未面临分流的患者相比，面临最高程度分流的患者被收治到具备心脏治疗技术医院的概率最低，心脏重症监护病房低4.4%，导管插入实验室和冠状动脉搭桥手术设施低3.4%。经历分流增加的患者接受导管插入术的可能性也降低了4.3%，1年死亡率高9.6%。
为大量黑人患者服务的医院更有可能处于分流状态，并且分流与获得心脏治疗技术的机会较差、接受血管重建术的概率较低以及长期死亡率结果较差相关。
