Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts’ ambulance diversion ban
Abstract Background The impact of ambulance diversion on potentially diverted patients, particularly racial/ethnic minority patients, is largely unknown. Treating Massachusetts’ 2009 ambulance diversion ban as a natural experiment, we examined if the ban was associated with increased concordance in...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-08358-8 |
| _version_ | 1798038031099232256 |
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| author | Amresh D. Hanchate William E. Baker Michael K. Paasche-Orlow James Feldman |
| author_facet | Amresh D. Hanchate William E. Baker Michael K. Paasche-Orlow James Feldman |
| author_sort | Amresh D. Hanchate |
| collection | DOAJ |
| description | Abstract Background The impact of ambulance diversion on potentially diverted patients, particularly racial/ethnic minority patients, is largely unknown. Treating Massachusetts’ 2009 ambulance diversion ban as a natural experiment, we examined if the ban was associated with increased concordance in Emergency Medical Services (EMS) patients of different race/ethnicity being transported to the same emergency department (ED). Methods We obtained Medicare Fee for Service claims records (2007–2012) for enrollees aged 66 and older. We stratified the country into patient zip codes and identified zip codes with sizable (non-Hispanic) White, (non-Hispanic) Black and Hispanic enrollees. For a stratified random sample of enrollees from all diverse zip codes in Massachusetts and 18 selected comparison states, we identified EMS transports to an ED. In each zip code, we identified the most frequent ED destination of White EMS-transported patients (“reference ED”). Our main outcome was a dichotomous indicator of patient EMS transport to the reference ED, and secondary outcome was transport to an ED serving lower-income patients (“safety-net ED”). Using a difference-in-differences regression specification, we contrasted the pre- to post-ban changes in each outcome in Massachusetts with the corresponding change in the comparison states. Results Our study cohort of 744,791 enrollees from 3331 zip codes experienced 361,006 EMS transports. At baseline, the proportion transported to the reference ED was higher among White patients in Massachusetts and comparison states (67.2 and 60.9%) than among Black (43.6 and 46.2%) and Hispanic (62.5 and 52.7%) patients. Massachusetts ambulance diversion ban was associated with a decreased proportion transported to the reference ED among White (− 2.7 percentage point; 95% CI, − 4.5 to − 1.0) and Black (− 4.1 percentage point; 95% CI, − 6.2 to − 1.9) patients and no change among Hispanic patients. The ban was associated with an increase in likelihood of transport to a safety-net ED among Hispanic patients (3.0 percentage points, 95% CI, 0.3 to 5.7) and a decreased likelihood among White patients (1.2 percentage points, 95% CI, − 2.3 to − 0.2). Conclusion Massachusetts ambulance diversion ban was associated with a reduction in the proportion of White and Black EMS patients being transported to the most frequent ED destination for White patients, highlighting the role of non-proximity factors in EMS transport destination. |
| first_indexed | 2024-04-11T21:34:39Z |
| format | Article |
| id | doaj.art-227ffca202564025be88cea7b8b42cdf |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-11T21:34:39Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-227ffca202564025be88cea7b8b42cdf2022-12-22T04:01:48ZengBMCBMC Health Services Research1472-69632022-08-0122111110.1186/s12913-022-08358-8Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts’ ambulance diversion banAmresh D. Hanchate0William E. Baker1Michael K. Paasche-Orlow2James Feldman3Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of MedicineDepartment of Emergency Medicine, Boston University School of MedicineSection of General Internal Medicine, Boston University School of MedicineDepartment of Emergency Medicine, Boston University School of MedicineAbstract Background The impact of ambulance diversion on potentially diverted patients, particularly racial/ethnic minority patients, is largely unknown. Treating Massachusetts’ 2009 ambulance diversion ban as a natural experiment, we examined if the ban was associated with increased concordance in Emergency Medical Services (EMS) patients of different race/ethnicity being transported to the same emergency department (ED). Methods We obtained Medicare Fee for Service claims records (2007–2012) for enrollees aged 66 and older. We stratified the country into patient zip codes and identified zip codes with sizable (non-Hispanic) White, (non-Hispanic) Black and Hispanic enrollees. For a stratified random sample of enrollees from all diverse zip codes in Massachusetts and 18 selected comparison states, we identified EMS transports to an ED. In each zip code, we identified the most frequent ED destination of White EMS-transported patients (“reference ED”). Our main outcome was a dichotomous indicator of patient EMS transport to the reference ED, and secondary outcome was transport to an ED serving lower-income patients (“safety-net ED”). Using a difference-in-differences regression specification, we contrasted the pre- to post-ban changes in each outcome in Massachusetts with the corresponding change in the comparison states. Results Our study cohort of 744,791 enrollees from 3331 zip codes experienced 361,006 EMS transports. At baseline, the proportion transported to the reference ED was higher among White patients in Massachusetts and comparison states (67.2 and 60.9%) than among Black (43.6 and 46.2%) and Hispanic (62.5 and 52.7%) patients. Massachusetts ambulance diversion ban was associated with a decreased proportion transported to the reference ED among White (− 2.7 percentage point; 95% CI, − 4.5 to − 1.0) and Black (− 4.1 percentage point; 95% CI, − 6.2 to − 1.9) patients and no change among Hispanic patients. The ban was associated with an increase in likelihood of transport to a safety-net ED among Hispanic patients (3.0 percentage points, 95% CI, 0.3 to 5.7) and a decreased likelihood among White patients (1.2 percentage points, 95% CI, − 2.3 to − 0.2). Conclusion Massachusetts ambulance diversion ban was associated with a reduction in the proportion of White and Black EMS patients being transported to the most frequent ED destination for White patients, highlighting the role of non-proximity factors in EMS transport destination.https://doi.org/10.1186/s12913-022-08358-8Emergency medical servicesambulance diversionEmergency departmentDisparityRaceEthnicity |
| spellingShingle | Amresh D. Hanchate William E. Baker Michael K. Paasche-Orlow James Feldman Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts’ ambulance diversion ban BMC Health Services Research Emergency medical services ambulance diversion Emergency department Disparity Race Ethnicity |
| title | Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts’ ambulance diversion ban |
| title_full | Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts’ ambulance diversion ban |
| title_fullStr | Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts’ ambulance diversion ban |
| title_full_unstemmed | Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts’ ambulance diversion ban |
| title_short | Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts’ ambulance diversion ban |
| title_sort | ambulance diversion and ed destination by race ethnicity evaluation of massachusetts ambulance diversion ban |
| topic | Emergency medical services ambulance diversion Emergency department Disparity Race Ethnicity |
| url | https://doi.org/10.1186/s12913-022-08358-8 |
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