Racial and Ethnic Health Disparities Due to Ambulance Diversion

救护车改道造成的种族和民族健康差异

• 批准号: 9028091
• 负责人: James Alan Feldman
• 金额: $ 53.68万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-15 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9028091
• 关键词: Accident and Emergency department; Acute myocardial infarction; Affect; Ambulances; Area; Boston; Cardiovascular system; Caring; Chronic; Chronic Obstructive Airway Disease; Clinical; Code; Cost Measures; Country; Data; Destinations; Diabetes Mellitus; Elderly; Emergency Department patient; Emergency department visit; Emergency medical service; Ethnic Origin; Health Care Costs; Healthcare; Heart failure; Home environment; Hospitals; Hyperlipidemia; Hypertension; Incidence; Income; Inpatients; Institute of Medicine (U.S.); Length of Stay; Life; Literature; Location; Low income; Lung; Massachusetts; Medical; Medicare; Methods; Minority; Myocardial Ischemia; Natural experiment; Outcome; Outcome Measure; Pathway interactions; Patient Care; Patient risk; Patients; Pattern; Provider; Public Policy; Publishing; Race; Recording of previous events; Records; Reporting; Research; Research Design; Rest; Risk; Sampling; Surveys; Time; Travel; Visit; adverse outcome; aged; base; beneficiary; cohort; cost; ethnic health disparity; evidence base; experience; health care service utilization; indexing; knowledge base; longitudinal database; mortality; novel; public health relevance; racial and ethnic; racial difference; racial disparity; residence; safety net; treatment as usual

 DESCRIPTION (provided by applicant): In 2007, the Institute of Medicine (IOM) characterized ambulance diversion (AD), the practice by which Emergency Departments (EDs) are temporarily closed, as "antithetical to quality medical care" and called for its "elimination". Nevertheless, A persists, with 45% of EDs and 70% of urban EDs reporting AD in the last published survey in 2003. AD has been associated with higher mortality, delayed treatment, and other adverse outcomes. Not examined hitherto, AD has the potential to exacerbate disparities by race/ethnicity and income. AD may also increase healthcare costs. However, the current literature on the impact of AD is based on data from convenience sampling and is limited by a dearth of experimental evidence. On 1/1/2009, Massachusetts became the first, and to date only, state to ban AD. Treating the state-imposed ban as a natural experiment, we propose to estimate the causal impact of AD on access, outcomes, and cost, focusing on the potentially differential effects by race/ethnicity and income. To better understand ambulance use and AD within the milieu of overall patient care, we will develop a national longitudinal database of ambulance use based on Medicare administrative data. Using longitudinal patient records, this data will be better suited to examine the determinants of ambulance use, outcomes, and the impact of AD across diverse patients. We will focus on older adults with a chronic cardiovascular or pulmonary condition. We will identify a national cohort of a stratified random sample of all Medicare beneficiaries aged 66 or older (N=1,000,000), with an oversample from Massachusetts, and obtain data on all healthcare utilization, including ambulance and ED visits, from 2006-2012. Given the primacy of residential location in examining ambulance and ED use, this sample will be stratified by race/ethnicity and residence zip code to enable comparison of diverse patients from the same area. For the subset of Boston residents (Boston cohort) we will merge data from the Boston Emergency Medical Services (EMS) from 2006-2012 for EMS-specific outcome measures. Our specific aims are to evaluate: (1) incidence of ambulance use and reliance, (2) differences by race/ethnicity and income in ambulance transport outcomes, and (3) impact of Massachusetts AD ban on outcomes of ambulance transport and other ED patients not transported by ambulance. The Institute of Medicine (IOM) has highlighted the "limited" research and knowledge base of EMS practices. Using novel data with national scope, this study will make significant contributions to this evidence base and inform public policy on AD regarding not only its impact on clinical outcomes, but also, its impact on disparities.

 描述（由申请人提供）：2007 年，医学研究所 (IOM) 将救护车改道 (AD)（急诊科 (ED) 暂时关闭的做法）定性为“与优质医疗服务背道而驰”，并呼吁“然而，A 仍然存在，在 2003 年最新发布的调查中，45% 的急诊室和 70% 的城市急诊室报告 AD。AD 与较高的死亡率相关。延迟治疗和其他不良后果尚未经过研究，AD 可能会加剧种族/民族和收入方面的差异，但目前有关 AD 影响的文献是基于便利抽样和收入的数据。由于缺乏实验证据，马萨诸塞州成为迄今为止第一个、也是迄今为止唯一一个禁止 AD 的州。访问广告，为了更好地了解整体患者护理环境中的救护车使用和 AD，我们将根据医疗保险管理数据开发一个国家救护车使用纵向数据库。通过纵向患者记录，这些数据将更适合检查救护车使用的决定因素、结果以及 AD 对不同患者的影响。我们将重点关注患有慢性心血管或肺部疾病的老年人。所有老年医疗保险受益人的分层随机样本66 岁或以上（N = 1,000,000），从马萨诸塞州进行过抽样，并获得了 2006 年至 2012 年所有医疗保健利用情况的数据，包括救护车和急诊室就诊。鉴于居住地点在检查救护车和急诊室使用方面的首要地位，该样本将按种族/民族和居住邮政编码进行分层，以便能够对来自同一地区的不同患者进行比较 对于波士顿居民子集（波士顿队列），我们将合并来自波士顿紧急医疗服务的数据。 (EMS) 从 2006 年到 2012 年，针对 EMS 特定结果测量，我们的具体目标是评估：(1) 救护车使用和依赖的发生率，(2) 救护车运输结果中种族/民族和收入的差异，以及 (3)马萨诸塞州 AD 禁令对救护车运输和其他非救护车运输的 ED 患者的影响强调了 EMS 实践的“有限”研究和知识库。这项研究将使用全国范围的新数据。作出重大贡献这一证据基础并为 AD 的公共政策提供信息，不仅涉及其对临床结果的影响，还涉及其对差异的影响。