Race/Ethnicity-Related and Payer-Related Disparities in the Timeliness of Emergency Care in U.S. Emergency Departments

Johnston, Valerie J.; Bao, Yuhua

doi:10.1353/hpu.2011.0050

Cited by 10 publications

(8 citation statements)

References 27 publications

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“…One main difference between the two settings is that a patient presenting to the infusion clinic is seen with less delay whereas, in the ED, delays in care due to overcrowding continue to occur . We and others have shown that delays in treatment in the ED occur more often in African Americans, and our prior research has demonstrated that, compared to individuals of the same race, wait times for people with SCD are longer on average than wait times for people with long bone fractures in the ED setting . This delay in treatment may lead to worsening of pain before treatment as patients may delay coming to the ED due to concerns over long wait times.…”

Section: Discussionmentioning

confidence: 94%

Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis

et al. 2015

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Most adults with sickle cell disease (SCD) receive care for their acute painful episodes in an emergency department (ED) setting. The purpose of this article is to describe the impact of opening a dedicated treatment center for adults with SCD [Sickle Cell Infusion Clinic (SCIC)] on patient outcomes and on hospital discharges for SCD. Descriptive data including demographics, time to first dose of narcotic, and pain scores were collected on patients presenting to the SCIC and ED. Maryland hospital discharge data were obtained from the Maryland Health Services Cost Review Commission. Analyses were conducted using T tests, χ2 tests, and simple generalized estimating equation regression models accounting for the clustered nature of observations, as appropriate. There were 3,874 visits to the SCIC by 361 unique patients; 85% of those visits resulted in the patient being sent home. During the same time period, there were 3,408 visits to the ED by 558 unique patients with SCD. The overall admission rate from the ED for these patients was 35.9% but decreased significantly over the time period with a rate of 20% in December 2011. There was a significant decrease in readmissions over time for the entire Baltimore Metro area with the likelihood of readmission decreasing by 7% over time. The SCIC model provides adults with SCD access to high quality care that decreases the need for hospital admission. Further research needs to be done to evaluate the cost effectiveness of this model. Am. J. Hematol. 90:376–380, 2015. © 2015 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 94%

Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis

et al. 2015

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“…The strongest predictor of LWCET was race. Previous studies have also found racial disparities among patient wait times and LWCET in the ED [ 2 , 3 , 5 , 7 , 16 , 17 ]. We observed a significant relationship between AI children and LWCET while accounting for potential confounding factors.…”

Section: Discussionmentioning

confidence: 96%

Leaving the emergency department without complete care: disparities in American Indian children

Weber

Ziegler

Kharbanda

et al. 2018

BMC Health Serv Res

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BackgroundChildren who leave the emergency department (ED) without complete evaluation or care (LWCET) have poorer outcomes in general. Previous studies have found that American Indian (AI) children have higher rates of LWCET than other racial or ethnic groups. Therefore, this study aims to examine LWCET in AI children by exploring differences by ED location and utilization patterns.MethodsThis is a retrospective cohort study of five EDs in the upper Midwest between June 2011 and May 2012. We included all visits by children aged 0–17 who identified as African American (AA), AI or White. Logistic regression was used to determine differences in LWCET by race and ED location controlling for other possible confounding factors including sex, age, insurance type, triage level, distance from ED, timing of visit, and ED activity level.ResultsLWCET occurred in 1.73% of 68,461 visits made by 47,228 children. The multivariate model revealed that AIs were more likely to LWCET compared to White children (Odds Ratio (OR) = 1.62, 95% Confidence Interval (CI) = 1.30–2.03). There was no significant difference in LWCET between AA and White children. Other factors significantly associated with LWCET included triage level, distance from the ED, timing of visit, and ED activity level.ConclusionOur results show that AI children have higher rates of LWCET compared to White children; this association is different from other racial minority groups. There are likely complex factors affecting LWCET in AI children throughout the upper Midwest, which necessitates further exploration.

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“…(7) Johnston and Bao found that compared to white patients, African-Americans and Hispanics were more likely to wait more than an hour to see a physician in the ED for treatment of chest pain or abdominal pain, even after controlling for potentially confounding factors including assigned triage priority and pain scores at triage. (8) Karve et al found that black stroke patients presenting to an ED had longer wait times to evaluation by an ED physician than did white stroke patients, also after accounting for potentially confounding factors such as assigned triage priority. (9)…”

Section: Discussionmentioning

confidence: 99%

“…(14–17) It is interesting to note that while Johnston and Bao found that black patients waited longer to see a physician when presenting with chest pain or abdominal pain, two painful conditions for which there is some measure of clinical uncertainty, no racial differences were found in wait times for treatment of lacerations in extremities, conditions for which there are clear objective signs of the underlying problem and course of action. (8)…”

Section: Discussionmentioning

confidence: 99%

The impact of race and disease on sickle cell patient wait times in the emergency department

Haywood¹,

Tanabe

Naik

et al. 2013

The American Journal of Emergency Medicine

106

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STUDY OBJECTIVE To determine whether or not patients with sickle cell disease (SCD) experience longer wait times to see a physician after arrival to an emergency department (ED) compared to patients with long bone fracture (LBF) and patients presenting with all other possible conditions (General Patient Sample), and to attempt to disentangle the effects of race and disease status on any observed differences. METHODS A cross-sectional, comparative analysis of year 2003 through 2008 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of nonfederal emergency department visits in the United States. Our primary outcome was wait time (in minutes) to see a physician after arrival to an ED. A generalized linear model was used to examine ratios of wait times comparing SCD visits to the two comparison groups. RESULTS SCD patients experienced wait times 25% longer than the General Patient Sample, though this difference was explained by the African-American race of the SCD patients. SCD patients waited 50% longer than did patients with LBF even after accounting for race and assigned triage priority. CONCLUSIONS Patients with SCD presenting to an ED for care experience longer wait times than other groups, even after accounting for assigned triage level. The African-American race of the SCD patients, and their status as having SCD itself, both appear to contribute to longer wait times for these patients. These data confirm patient anecdotal reports and are in need of intervention.

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Race/Ethnicity-Related and Payer-Related Disparities in the Timeliness of Emergency Care in U.S. Emergency Departments

Cited by 10 publications

References 27 publications

Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis

Impact of a dedicated infusion clinic for acute management of adults with sickle cell pain crisis

Leaving the emergency department without complete care: disparities in American Indian children

The impact of race and disease on sickle cell patient wait times in the emergency department

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