Monday, February 13, 2023 | The Latest Research, Commentary, And News From Health Affairs
Dear
John,
Today's newsletter comes from Lawrence H. Brown, a professor at the University of Texas at Austin, and Remle P. Crowe, the Director of Clinical and Operational Research at ESO.
Our research broadly aims to improve the delivery of emergency medical services (EMS),
including studies of patient-level interventions, EMS systems design, and EMS-related health policy.
We are not experts in health disparities, but we understand disparities can manifest across the full spectrum of health care, including EMS care.
We were inspired by the work of Amresh Hanchate and colleagues, who reported that Black Medicare enrollees transported by ambulance were approximately 5 percent less likely to be
taken to the primary receiving hospital for White patients residing in the same ZIP code.
Hispanic patients were nearly 3 percent less likely to be taken to the primary receiving hospital for White patients.
Our goal was to evaluate disparities in transport destinations in a broader sample of patients of all ages, regardless of payor, and using the ZIP code of the emergency scene location as the geographic unit of analysis.
We also used a different analytic tool, the Dissimilarity Index, which allowed us to measure unevenness in the distributions of patients across all the available destination hospitals.
We studied more than 3 million ambulance transports from 2,813 ZIP codes.
In half of the studied ZIP codes, at least 8 percent of racial or ethnic minority patients would have had to have been
transported to a different hospital to achieve even distribution of White and minority patients across the available destination hospitals.
In two out of five ZIP codes, the discordance in transport destinations exceeded 10 percent.
We cannot conclude from our data that these discordances in ambulance transport destinations result in disparities in medical care or outcomes, but previous studies have demonstrated that differences in where White and minority patients receive medical care can contribute to disparities in care.
We have no reason to think that is different for patients transported by ambulance.
We support efforts to increase EMTs' and paramedics' awareness of their own implicit biases, and efforts to increase diversity, equity, and inclusion among the EMS workforce.
However, we want to emphasize these data most likely reflect systemic factors influencing patients' health care journeys, and not explicit
encounter-level decisions to transport White and racial or ethnic minority patients to different hospitals.
There can be good reasons for transporting patients from within the same ZIP code to different hospitals, but in the absence underlying systemic drivers, we would expect those factors to be nearly evenly distributed among White and racial or ethnic minority patients.
It appears that EMS encounters with racial or ethnic minority patients are as susceptible as the rest of health care to the effects of disproportionate poverty, reduced access to employment and health insurance, geographic segregation, and even historical segregation and racism within the health care system.
This matters: More than 20 million patients are transported to a hospital by EMS each year, and millions more receive medical evaluations
and on-scene care without transport.
Identifying this phenomenon is only a beginning.
We hope that our work will further inspire those who are experts in health disparities to incorporate the EMS phase of care in their ongoing efforts to study, mitigate, and eliminate disparities related to race and ethnicity.
Today in Forefront,Noa Krawczyk and coauthors propose immediate and long-term investments that local jurisdictions can make with opioid settlement funds to address opioid use disorder in their communities. If you're enjoying articles from Forefront, you can bookmark the website to never miss an article.
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