Objective-Prolonged emergency department (ED) wait time and length of visit reduce quality of care and increase adverse events. Previous studies have not examined hospital-level performance on ED wait time and visit length in the United States. The purpose of this study is to describe hospitallevel performance on ED wait time and visit length.Methods-We conducted a retrospective cross-sectional study of a stratified random sampling of 35,849 patient visits to 364 non-Federal U.S. hospital EDs in 2006, weighted to represent 119,191,528 visits to 4,654 EDs. Measures included EDs' median wait times and visit lengths, EDs' median proportion of patients seen by a physician within the time recommended at triage, and EDs' median proportion of patients dispositioned within 4 or 6 hours.Results-In the median ED, 78.3% (interquartile range [IQR], 63.2%, 89.5%) of all patients, and 66.9% (IQR, 52.0%, 81.9%) of patients who were triaged to be seen within one hour were seen by a physician within the target triage time. A total of 30.5% of EDs achieved the triage target for more than 90% of their patients; 13.8% of EDs achieved the triage target for 90% or more of patients triaged to be seen within an hour. In the median ED, 76.3% (IQR 54.4%, 93.9%) of patients were admitted within 6 hours. A total of 47.7% of EDs admitted more than 90% of their patients within 6 hours, but only 24.5% of EDs admitted more than 90% of their patients within 4 hours.Conclusions-A minority of hospitals consistently achieved recommended wait times for all ED patients, and fewer than half of hospitals consistently admitted their ED patients within 6 hours.

OBJECTIVE: To determine prevalence and correlates of need and unmet need for care coordination in a national sample of children with mental health conditions. METHODS: Using data from the 2007 National Survey of Children’s Health, we identified children aged 2 to 17 years with ≥1 mental health condition (attention-deficit/hyperactivity disorder, anxiety disorder, conduct disorder, or depression) who had received ≥2 types of preventive or subspecialty health services in the past year. We defined 2 outcome measures of interest: (1) prevalence of need for care coordination; and (2) prevalence of unmet need for care coordination in those with a need. Logistic regression models were used to estimate associations of clinical, sociodemographic, parent psychosocial, and health care characteristics with the outcome measures. RESULTS: In our sample (N = 7501, representing an estimated 5 750 000 children), the prevalence of having any need for care coordination was 43.2%. Among parents reporting a need for care coordination, the prevalence of unmet need was 41.2%. Higher risk of unmet need for care coordination was associated with child anxiety disorder, parenting stress, lower income, and public or no insurance. Parents reporting social support and receipt of family-centered care had a lower risk of unmet need for care coordination. CONCLUSIONS: Approximately 40% of parents of children with mental health conditions who reported a need for care coordination also reported that their need was unmet. Delivery of family-centered care and enhancing family supports may help to reduce unmet need for care coordination in this vulnerable population.

The D2B Alliance reached its goal of 75% of patients with STEMI having D2B times within 90 min by 2008.

Background: Despite the disproportionate incarceration of minorities in the United States, little data exist investigating how being incarcerated contributes to persistent racial/ethnic disparities in chronic conditions. We hypothesized that incarceration augments disparities in chronic disease. Methods:Using data from the New York City Health and Nutrition Examination Study, a community-based survey of 1999 adults, we first estimated the association between having a history of incarceration and the prevalence of asthma, diabetes, hypertension using propensity score matching methods. Propensity scores predictive of incarceration were generated using participant demographics, socioeconomic status, smoking, excessive alcohol and illicit drug use, and intimate partner violence. Among those conditions associated with incarceration, we then performed mediation analysis to explore whether incarceration mediates racial/ethnic disparities within the disease.Results: Individuals with a history of incarceration were more likely to have asthma compared to those without (13% vs. 6%, p < 0.05) and not more likely to have diabetes or hypertension, after matching on propensity scores. Statistical mediation analysis revealed that increased rates of incarceration among Blacks partially contribute to the racial disparity in asthma prevalence. Conclusion:Having been incarcerated may augment racial disparities in asthma among NYC residents. Eliminating health disparities should include a better understanding of the role of incarceration and criminal justice policies in contributing to these disparities. BackgroundIncarceration has become increasingly frequent in the lives of Americans in the past two decades, with more than 2.3 million individuals behind bars[1] and an additional 8 million under the supervision of parole and probation [2]. Racial and ethnic minorities are disproportionately represented among current and former inmates [3]. For instance, while African-Americans make up 13% of the general US population, they constitute 28% of all arrests and 40% of all people held in prisons and jails, whereas Whites make up 67% of the US population and 70% of all arrests, but only 40% of all people held in state prisons or local jails [3]. Additionally, Black and Latino inmates serve longer sentences for similar crimes compared to their White counterparts.

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Background Although frequently used to track healthcare disparities, patient race/ethnicity data collected by hospitals can be unreliable, particularly for smaller minority groups. We sought to determine if the racial/ethnic distribution of hospitalized patients shifted after implementation of a statewide initiative to standardize data collection practices. Methods We conducted a difference-in-differences analysis of the State Inpatient Databases to estimate changes in the proportion of patients identified as non-Hispanic white, non-Hispanic black, Hispanic, Asian/Pacific Islander, and “other,” before (2005–2006) and after (2008–2009) standardized practices were implemented in New Jersey (NJ) relative to New York (NY), a state with similar demographics but no changes to data collection. Results Among 12,552,702 hospital discharges, modest relative changes were noted in the proportion of patients identified as non-Hispanic white (+1.1%; 95% CI +0.9 to +1.2) and non-Hispanic black (+1.6%; 95% CI +1.1 to +2.1) in NJ that were attributed to its use of standardized data collection practices as compared with NY. Larger relative changes were noted in the proportion of patients identified as Hispanic (−7.1%; 95% CI −7.8 to −6.4), Asian/Pacific Islander (+26.5%; 95% CI +25.1 to +27.9) and “other” (−24.6%; 95% CI −26.4 to −22.8). This pattern was largely consistent in analyses stratified by gender, age, and Major Diagnostic Category. Conclusions Measurement of healthcare disparities fundamentally depends on the racial/ethnic categorization of individuals. By redistributing substantial proportions of patients across smaller minority groups, standardized data collection could lead to shifts in estimates of healthcare disparities for these rapidly growing populations.