Structural Racism and Discrimination in Emergency Department Transfers: Unintended Consequences of the Emergency Medical Treatment and Labor Act (EMTALA)

急诊科转诊中的结构性种族主义和歧视：《紧急医疗和劳动法》(EMTALA) 的意外后果

• 批准号: 10473958
• 负责人: CHARLEEN HSUAN
• 金额: $ 71.46万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10473958
• 关键词: Accident and Emergency department; Acquired Immunodeficiency Syndrome; Address; Admission activity; Behavior; Black race; Burn Units; California; Caring; Data; Discrimination; Doctor of Philosophy; Emergency Care; Emergency Department patient; Employment; Ensure; Ethnic Origin; Goals; Grant; Health; Hispanic; Hospitals; Insurance; Insurance Coverage; Laws; Length of Stay; Measures; Medicaid; Medical emergency; Medicare; Mental disorders; Minority; Mission; National Institute on Minority Health and Health Disparities; New York; Not Hispanic or Latino; Outcome; Ownership; Patient Transfer; Patient-Focused Outcomes; Patients; Physicians; Policies; Protocols documentation; Public Health; Public Hospitals; Quality of Care; Race; Regulation; Research; Research Personnel; Research Support; Structural Racism; System; Variant; Work; experience; health care settings; health disparity; health equity; hospital readmission; improved; innovation; inpatient service; insight; interest; marginalized population; minority patient; mortality; non-compliance; payment; preservation; racial difference; racial disparity; safety net; socioeconomic diversity; trauma units

PROJECT SUMMARY Because hospitals transfer emergency department patients when they lack capability, in order to ensure that access to emergency care is equitable, it is critical that these transfers do not vary by race, ethnicity, or payer. This goal is enshrined in the Emergency Medical Treatment and Labor Act (EMTALA), which requires Medicare- participating hospitals to provide emergency care to all patients, regardless of race, ethnicity, or insurance status. Yet disparities in emergency department transfers exist. The hypothesis of the proposed study is that these disparities reflect structural racism and discrimination; hospitals may circumvent the goals of EMTALA by leveraging the “nondiscrimination provision” of that law, which requires that hospitals with specialized capabilities accept EMTALA transfers if they have capacity. The project will examine strategic use of the nondiscrimination provision in the following three aims: (1) measure differences in ED length of stay for minority versus White non- Hispanic transfer patients, and determine whether differences in length of stay are associated with disparities in patient outcomes; (2) assess whether minority, versus White non-Hispanic, ED patients requiring specialized care are less likely to be transferred to hospitals within the same ownership system; and (3) determine whether minority ED patients, compared with White non-Hispanic patients, are more likely to be transferred to a safety- net hospital. All analyses will examine differences by race/ethnicity and by race/ethnicity for patients with the same payer. The proposed research is innovative because it identifies structural racism and discrimination through variations in organizational behavior, and permits us to disentangle differences by race/ethnicity versus payer. Furthermore, it allows us to examine not just whether minorities are less likely to experience an ED transfer than White non-Hispanic patients, but also whether there are differences in the timing of the ED transfer and whether minority patients are more likely to be transferred to different hospitals than White non-Hispanic patients. The proposed project is significant because these insights may be used to improve policy by providing evidence whether improving the equity of ED transfers might be best addressed by promulgating regulations to promote non-disparate emergency department transfers, or expanding protocolization of these transfers.

项目摘要 因为医院在缺乏能力时转移急诊科患者，以确保 获得紧急护理是公平的，至关重要的是，这些转移不会因种族，种族或付款人而异。 这项目标是在《紧急医疗和劳工法》（EMTALA）中所包含的，该法案需要Medicare- 参加医院，为所有患者提供急诊护理，无论种族，种族或保险状况如何。 然而，存在紧急部门转移的分布。拟议研究的假设是 差异反映了结构性的种族主义和歧视；医院可以规避Emtala的目标 利用该法律的“非歧视规定”，该法律要求具有专门功能的医院 如果具有能力，请接受Emtala转移。该项目将研究非歧视的战略使用 以下三个目标中的规定：（1）衡量少数族裔与白人非 - 西班牙裔转移患者，并确定住院时间差异是否与分布相关 患者的结果； （2）评估少数族裔与白人非西班牙裔，ED患者是否需要专业 在同一所有权系统内，不太可能将其转移到医院； （3）确定是否 与白人非西班牙裔患者相比，少数ED患者更有可能被转移到安全性 - 净医院。所有分析将检查种族/种族和种族/民族的差异 同一付款人。拟议的研究具有创新性，因为它确定了结构性种族主义和歧视 通过组织行为的变化，并允许我们通过种族/种族与 付款人。此外，它使我们不仅可以检查少数民族是否不太可能体验ED 转移比白人非西班牙裔患者，但在ED转移的时机上是否存在差异 以及少数族裔患者是否更有可能被转移到不同的医院，而不是白人非西班牙裔 患者。拟议的项目很重要，因为这些见解可以通过提供来改善政策 通过颁布法规，可以最好地解决改善ED转让的权益的证据 促进非旁白急诊科转移或扩大这些转移的协议。