White patients transported to closest ED more often than blacks, Hispanics

White Medicare patients are more likely to be transported to the closest emergency department (ED) than their black or Hispanic counterparts, according to a new study out of Boston University’s School of Medicine.

Researchers recently set out to discover whether black and Hispanic Medicare patients are likely to be transported by emergency medical services (EMS) to the same emergency departments as white Medicare patients living in the same area—and to the closest available ED, according to proper protocol.

The study, published in JAMA Network Open, looked at data in Medicare claims from more than 4,000 zip codes—representing 460,000 ED visits—between 2006 and 2012.

Data revealed that white patients were transported to the closest ED, as is recommended by the American College of Emergency Physicians, about 61% of the time.

Meanwhile, black patients were transported to the closest ED 5.3% less often, and Hispanic patients were taken to the nearest ED about 2.5% less often.

Similarly, among patients with high-risk acute conditions, the proportion of patients transported to the reference ED was 6.7% lower for blacks and 2.6% lower for Hispanic enrollees than it was for whites (61.5%).

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Instead, the data revealed black and Hispanic Medicare patients were more likely to be transported to a safety-net ED compared to white patients living within the same zip code. Whites were sent to safety-net EDs 18.5% of the time compared to a difference of 2.7% more for black enrollees and 1.9% more for Hispanic enrollees.

"Overall, 40% of all patients were not transported to the reference ED/hospital; even in neighborhoods with either one or no ED/hospital in a 10-mile radius, 30% were not transported to the reference ED/hospital. This rate applied to all patients," Amresh Hanchate, associate professor of medicine at Boston University School of Medicine, told FierceHealthcare.

Although proximity is important, previous studies reveal that the capabilities of an ED are also significant when EMS or patients make decisions about which ED to visit. For example, patients with a history of using inpatient care at a specific hospital may prefer to be transported to their so-called "home ED."

In zip codes with more than one ED within 10 miles, the rate of transports via proximity for white patients was 72.9%, about the same percentage for black enrollees, and just 2.6% lower for Hispanic enrollees. But in a zip code with five or more EDs within 10 miles, the rate among transport to the closest ED for whites was 51%, and that number was 8.4% lower for blacks and 2.8% lower for Hispanics.

A similar pattern arose for all zip codes in the 16 largest U.S. cities. However, the mean distance traveled by transport for white patients in the largest cities was 0.16 miles shorter than it was for black patients and 0.19 miles for Hispanic patients.

In conclusion, black and Hispanic Medicare enrollees were less likely to be transported to the most frequented ED destination than white patients living in the same zip code. And black and Hispanic enrollees were more likely to be transported to safety-net EDs compared to white enrollees.

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Findings from the study also show that ED destinations of EMS transports may not be guided primarily by proximity, even in areas with one or no EDs within a 10-mile vicinity. More than 27% of patients were transported to other EDs, and that number increased proportionally to the increase in EDs within the vicinity.

The study also supports the idea that family or patient choice of ED may have a big impact on transport. Although data were not given specifically for ED destination by patient preferability, there was considerable overlap in the ED destination patterns of EMS transports and walk-ins (61.3% versus 52.9%), supporting this notion that patients have a choice in their destination hospital.

Hanchate says that the study leaves researchers questioning whether going to the nearest ED has any implication for patient outcomes, particularly for patients with high-risk conditions such as stroke, heart attacks or trauma.

"Unfortunately our data does not include information on patient preference or other reasons for determining the destination ED/hospital. So we cannot determine whether racial/ethnic differences in ED destination are due to different patient preferences," he added.