Do patients hospitalised in high-minority hospitals experience more diversion and poorer outcomes? A retrospective multivariate analysis of Medicare patients in California
Abstract
Objective: We investigated the association between
crowding as measured by ambulance diversion and
differences in access, treatment and outcomes between
black and white patients.
Design: Retrospective analysis.
Setting: We linked daily ambulance diversion logs
from 26 California counties between 2001 and 2011 to
Medicare patient records with acute myocardial
infarction and categorised patients according to hours
in diversion status for their nearest emergency
departments on their day of admission: 0, <6, 6 to
<12 and ≥12 h. We compared the amount of diversion
time between hospitals serving high volume of black
patients and other hospitals. We then use multivariate
models to analyse changes in outcomes when
patients faced different levels of diversion, and
compared that change between black and white
patients.
Participants: 29 939 Medicare patients from 26
California counties between 2001 and 2011.
Main outcome measures: (1) Access to hospitals
with cardiac technology; (2) treatment received; and
(3) health outcomes (30-day, 90-day, and 1-year death
and 30-day readmission).
Results: Hospitals serving high volume of black
patients spent more hours in diversion status
compared with other hospitals. Patients faced with the
highest level of diversion had the lowest probability of
being admitted to hospitals with cardiac technology
compared with those facing no diversion, by 4.4% for
cardiac care intensive unit, and 3.4% for
catheterisation laboratory and coronary artery bypass
graft facilities. Patients experiencing increased
diversion also had a 4.3% decreased likelihood of
receiving catheterisation and 9.6% higher 1-year
mortality.
Conclusions: Hospitals serving high volume of black
patients are more likely to be on diversion, and
diversion is associated with poorer access to cardiac
technology, lower probability of receiving
revascularisation and worse long-term mortality
outcomes.
Description
The article of record as published may be found at http://dx.doi.org/10.1136/bmjopen-2015-
010263
Rights
This publication is a work of the U.S. Government as defined in Title 17, United States Code, Section 101. Copyright protection is not available for this work in the United States.Collections
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