Department of Health Policy & Administration, Pennsylvania State University, State College, Pennsylvania, USA.
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Health Serv Res. 2024 Apr;59(2):e14276. doi: 10.1111/1475-6773.14276. Epub 2024 Jan 17.
To examine racial/ethnic differences in emergency department (ED) transfers to public hospitals and factors explaining these differences.
ED and inpatient data from the Healthcare Cost and Utilization Project for Florida (2010-2019); American Hospital Association Annual Survey (2009-2018).
Logistic regression examined race/ethnicity and payer on the likelihood of transfer to a public hospital among transferred ED patients. The base model was controlled for patient and hospital characteristics and year fixed effects. Models II and III added urbanicity and hospital referral region (HRR), respectively. Model IV used hospital fixed effects, which compares patients within the same hospital. Models V and VI stratified Model IV by payer and condition, respectively. Conditions were classified as emergency care sensitive conditions (ECSCs), where transfer is protocolized, and non-ECSCs. We reported marginal effects at the means.
DATA COLLECTION/EXTRACTION METHODS: We examined 1,265,588 adult ED patients transferred from 187 hospitals.
Black patients were more likely to be transferred to public hospitals compared with White patients in all models except ECSC patients within the same initial hospital (except trauma). Black patients were 0.5-1.3 percentage points (pp) more likely to be transferred to public hospitals than White patients in the same hospital with the same payer. In the base model, Hispanic patients were more likely to be transferred to public hospitals compared with White patients, but this difference reversed after controlling for HRR. Hispanic patients were - 0.6 pp to -1.2 pp less likely to be transferred to public hospitals than White patients in the same hospital with the same payer.
Large population-level differences in whether ED patients of different races/ethnicities were transferred to public hospitals were largely explained by hospital market and the initial hospital, suggesting that they may play a larger role in explaining differences in transfer to public hospitals, compared with other external factors.
研究急诊科（ED）转往公立医院的种族/民族差异及解释这些差异的因素。
佛罗里达州医疗保健成本和利用项目的 ED 和住院数据（2010-2019 年）；美国医院协会年度调查（2009-2018 年）。
使用逻辑回归分析在 ED 转院患者中，种族/民族和支付方对转往公立医院的可能性的影响。基础模型控制了患者和医院特征以及年份固定效应。模型 II 和 III 分别加入了城市性和医院转诊区域（HRR）。模型 IV 使用了医院固定效应，该效应比较了同一医院内的患者。模型 V 和 VI 分别根据支付方和病情对模型 IV 进行分层。将病情分为急诊护理敏感病情（ECSCs）和非 ECSCs，前者的转院是按规定进行的。我们报告了平均值处的边际效应。
数据收集/提取方法：我们研究了 1265588 名从 187 家医院转来的成年 ED 患者。
除了同一初始医院（除创伤外）的相同支付方的 ECSC 患者外，在所有模型中，黑人患者被转往公立医院的可能性都高于白人患者。在基础模型中，与白人患者相比，西班牙裔患者更有可能被转往公立医院，但在控制 HRR 后，这种差异发生了逆转。在同一医院、同一支付方的情况下，与白人患者相比，西班牙裔患者被转往公立医院的可能性要低 0.6-1.2 个百分点。
不同种族/民族的 ED 患者是否被转往公立医院存在较大的人群水平差异，这主要是由医院市场和初始医院解释的，这表明与其他外部因素相比，它们可能在解释转往公立医院的差异方面发挥更大的作用。
