09 Sep Patient Preferences Could Drive Racial Disparities in EMS Emergency Room Transport
MedicalResearch.com Interview with:
Amresh D Hanchate, PhD
Research Assistant Professor
Department of Medicine, School of Medicine
MedicalResearch.com: What is the background for this study?
Response: National guidelines require EMS transportation to the nearest suitable hospital. To what extent this occurs and whether this varies by the race and ethnicity of the patient is unknown since there is little to no prior research on destination patterns of EMS-transported patients to hospitals.
MedicalResearch.com: What are the main findings?
Response: Our main findings are that (a) a sizable proportion (~40 percent) of all EMS transports are not to the nearest ED, and (b) this proportion is even larger among racial/ethnic minorities. While our data do not contain information to examine the reasons, the findings have potential implications for patient outcomes that need to be further explored.
MedicalResearch.com: What should readers take away from your report?
Response: While the recommendation is for transport to the nearest/quickest ED destination, our study found that a large proportion bypass the nearest emergency department. This calls for further examination of the reasons for bypassing; is it patient choice or some other reason?
MedicalResearch.com: Is there anything else you would like to add?
Response: Our data does not include information to examine the reasons for the disparities. As an indirect approach we also examined destination emergency department of patients who “walk-in” to the ED (i.e., not using EMS). We found quite a bit of overlap in the patterns across all racial/ethnic groups. To the extent that this “walk-in” pattern represents patient preferences, the implication is that patient or family choice for specific ED may be driving the observed differences in EMS transport destination.
We have recognized several limitations; importantly, (a) we do not know the patient’s pick-up street location; instead we used patient’s residence zip code as the basis of distance calculation, and (b) we do not have data on severity of patient status at the time of EMS transport. Having this information would be helpful in arriving at more definitive estimates of disparities.
Hanchate AD, Paasche-Orlow MK, Baker WE, Lin M, Banerjee S, Feldman J. Association of Race/Ethnicity With Emergency Department Destination of Emergency Medical Services Transport. JAMA Netw Open. Published online September 06, 20192(9):e1910816. doi:10.1001/jamanetworkopen.2019.10816
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