Pack Christine E, Partain Andrew T, Crowe Remle P, Brown Lawrence H
Christine E. Pack, University of Texas, Austin, Texas.
Andrew T. Partain, University of Texas.
Health Aff (Millwood). 2023 Feb;42(2):237-245. doi: 10.1377/hlthaff.2022.00628.
Patients in the US belonging to racial or ethnic minority groups often receive medical care in different hospitals than White patients, which contributes to health care disparities. We explored whether ambulance transport destinations contribute to this phenomenon. Using a national emergency medical services research data set for calendar year 2020, we made within-ZIP code comparisons of the transport destinations for White patients and non-White patients transported by ambulance from emergency scenes. We used the dissimilarity index to measure transport destination discordances and decided a priori that a more than 5 percent difference in transport destinations (that is, dissimilarity index >0.05) would be practically meaningful. We found meaningful differences in the destination hospitals for White and non-White patients transported by ambulance from locations in the same ZIP code. The median ZIP code dissimilarity index was 0.08, 64 percent of ZIP codes had a dissimilarity index above 0.05, and 61 percent of patients were transported from ZIP codes with a dissimilarity index above 0.05. Forty-one percent of ZIP codes had a dissimilarity index above 0.10, and one-third of the patients were transported from those ZIP codes. These data indicate that ambulance transport destinations contribute to discordances in where White and non-White patients receive medical care.
在美国，属于少数种族或族裔群体的患者通常与白人患者在不同的医院接受医疗护理，这加剧了医疗保健方面的差异。我们探讨了救护车转运目的地是否导致了这一现象。利用2020年日历年的全国紧急医疗服务研究数据集，我们对从紧急现场由救护车转运的白人患者和非白人患者的转运目的地进行了邮政编码区内的比较。我们使用差异指数来衡量转运目的地的不一致性，并事先确定转运目的地超过5%的差异（即差异指数>0.05）在实际中具有意义。我们发现，从同一邮政编码区地点由救护车转运的白人患者和非白人患者的目的地医院存在有意义的差异。邮政编码区差异指数的中位数为0.08，64%的邮政编码区差异指数高于0.05，61%的患者是从差异指数高于0.05的邮政编码区转运来的。41%的邮政编码区差异指数高于0.10，三分之一的患者是从这些邮政编码区转运来的。这些数据表明，救护车转运目的地导致了白人患者和非白人患者接受医疗护理地点的不一致。
