Does a Person’s Race/Ethnicity Determine Their Emergency Department Destination?

Black and Hispanic patients are more likely to be transported by emergency medical services (EMS) to a safety-net hospital emergency department (ED) than white patients living in the same area, according to a study published in JAMA Network Open.

In this cohort study, researchers assessed 864,750 Medicare enrollees from 4,175 selected zip codes who had 458,701 EF visits by way of EMS transport from January 2006 to December 2012. The study population of interest were 66 years or older with continuous fee-for-service. The researchers evaluated zip codes with a sizable count (more than 10) of Hispanic, non-Hispanic black, and non-Hispanic white enrollees to compare EMS use across racial/ethnic subgroups. The primary study endpoint measure was specified as whether an EMS transport destination was the most frequent ED destination among white patients. The secondary endpoints were defined as whether the ED destination was a safety-net hospital, and the distance of EMS transport from the ED destination. The researchers conducted data analysis from December 18, 2018, to July 7, 2019.

The results showed that of all EMS-transported enrollees, 26.1% (127 555) were younger than 75 years, and most were women (66.8%). The researchers observed that the proportion of white patients transported to the reference ED was 61.3% (95% CI, 61.0% to 61.7%), and this rate was lower among black enrollees (difference of −5.3%; 95% CI, −6.0% to −4.6%) and Hispanic enrollees (difference of −2.5%; 95% CI, −3.2% to −1.7%). They discerned a similar pattern among patients with high-risk acute conditions, with a proportion transported to the reference ED of 61.5% (95% CI, 60.7% to 62.2%) among white enrollees, compared to a lower proportion among black enrollees (difference of −6.7%; 95% CI, −8.3% to −5.0%) and Hispanic enrollees (difference of –2.6%; 95% CI, –4.5% to –0.7%).

Minorities Sent to Safety-Net Facilities

Moreover, in major US cities, the researchers observed a larger black-white discordance in ED destination (−9.3%; 95% CI, −10.9% to −7.7%). The results indicate that Black and Hispanic patients were more likely to be transported to a safety-net ED compared with their white counterparts; the proportion transported to a safety-net ED among white enrollees (18.5%; 95% CI, 18.1% to 18.7%) was lower compared with that among black enrollees (difference of 2.7%; 95% CI, 2.2% to 3.2%) and Hispanic enrollees (difference of 1.9%; 95% CI, 1.3% to 2.4%).

“Analyzing population representative data, this study found that Medicare enrollees from the same location who used EMS for emergent conditions were transported to different EDs, with increased divergence in areas with multiple EDs in the vicinity. In all geographic areas, a sizable proportion of black and Hispanic patients were transported to different EDs compared with their white counterparts living in the same zip code,” the study authors wrote in their conclusion.

They added that: “Considerable similarity was observed in the pattern of ED destinations between patients transported by EMS and walk-in patients, suggesting that patient choice is a potential determinant. Future research is needed to understand the reasons for the divergence in ED destination by EMS transport and the extent to which this divergence may be associated with patient outcomes; the results of such research may inform the development of better EMS protocols.”