A statistically significant difference exists when it comes to what hospitals white and nonwhite patients are transported to by ambulance, according to a study published this week in Health Affairs.
“We found meaningful differences in the destination hospitals for white and non-white patients transported by ambulance from locations in the same ZIP code,” concluded researchers with the University of Texas.
The authors noted that their findings should not be interpreted as meaning that emergency medical services staff who operate ambulances preferentially transport white patients to hospitals within their ZIP codes while taking nonwhite residents out of their neighborhoods, but rather place the onus on systemic drivers of segregation in healthcare.
Researchers obtained data from the 2020 ESO Data Collaborative, where EMS companies can voluntarily contribute de-identified information from electronic health records. For the purposes of this study, ESO also provided the ZIP code for each location where an ambulance picked up a patient. The data represent 9.8 million EMS calls by about 2,000 ambulance companies in the U.S. in 2020.
The populations differed in a few respects. White patients were generally older, were more likely to be transported from rural areas and were more likely to be from affluent ZIP codes.
The study found “meaningful differences” when it came to transporting white and nonwhite patients within the same ZIP code.
“In half of the studied zip codes, at least 8% of white patients would have had to be transported to different hospitals to achieve evenness in the transport destinations of white and non-white patients,” the study states. “The level of transport destination discordance exceeded our 5% threshold in nearly two-thirds of the included zip codes; 61% of all patients were transported from those zip codes.”
Researchers acknowledged that achieving the right racial balance in terms of what patients are transported to which hospitals might be implausible. However, the “race-related discordance in hospital destinations was appreciably greater than the presumably random discordance we observed when comparing the destinations for even- versus odd-aged patients.”
The study also acknowledges that patients often ask to be taken to a certain hospital.
“That a substantial proportion of the discordance in transport destinations can be attributed to patient choice does not mean that the discordances are inconsequential,” the study states. “Patient choice is a complex, multifaceted construct that should not be misconstrued as independent of structural or systemic drivers of segregation.”
Social determinants of health in different ZIP codes might play a part, according to the study. Logistical factors also likely play a role, the researchers said. There may be a traffic jam on the route to the nearest hospital, for example.
In addition, certain patients may need the sort of specialty care provided by a hospital not in the patient’s zip code.
“Our stratified analyses send a mixed message in this regard: Destination discordances were more frequent when patients were transported emergently (that is, with lights and sirens), suggesting that patient condition could partially explain differences in destination decisions,” the study said. “In contrast, discordances were less frequent when patients were explicitly documented as being transported to the closest hospital.”