ArticleBMJ open2016
Do patients hospitalised in high-minority hospitals experience more diversion and poorer outcomes? A retrospective multivariate analysis of Medicare patients in California.
Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
17 citing papers in PubMed, 30 citations in OpenAlex.
- Shorter Emergency Department Boarding Times in Hospitals With Better Nurse Staffing.Journal of emergency nursing · 2026Article
- Medicaid Primary Care Utilization and Area-Level Social Vulnerability.JAMA health forum · 2025Article
- Racial and Socioeconomic Disparities in California Ambulance Patient Offload Times.JAMA network open · 2025Article
- Race and Ethnicity Disparities in Management and Outcomes of Critically Ill Adults with Acute Respiratory Failure.Critical care clinics · 2024Review
- Left Without Being Seen: Nurse Work Environment and Timely Outcomes in New York and Illinois Emergency Departments.Journal of emergency nursing · 2024Article
- Ambulance service recognition of health inequalities and activities for reduction: An evidence and gap map of the published literature.British paramedic journal · 2024Article
- How do current police practices impact trauma care in the prehospital setting? A scoping review.Journal of the American College of Emergency Physicians open · 2023Article
- A Conceptual Framework for Optimizing the Equity of Hospital-Based Emergency Care: The Structure of Hospital Transfer Networks.The Milbank quarterly · 2023Article
- Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts' ambulance diversion ban.BMC health services research · 2022Article
- Structural Discrimination in Emergency Care: How a Sick System Affects Us All.Med (New York, N.Y.) · 2022Article
- Article
- Effects of Medicaid expansion on access, treatment and outcomes for patients with acute myocardial infarction.PloS one · 2020Article
- Association of Hospital Racial Composition and Payer Mix With Mortality in Acute Coronary Syndrome.Journal of the American Heart Association · 2019Article
- Ambulance diversions following public hospital emergency department closures.Health services research · 2019Article
- Race Differences in Gastrostomy Tube Placement After Stroke in Majority-White, Minority-Serving, and Racially Integrated US Hospitals.Dysphagia · 2018Article
- Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction.The western journal of emergency medicine · 2017Article
- Impact Of Ambulance Diversion: Black Patients With Acute Myocardial Infarction Had Higher Mortality Than Whites.Health affairs (Project Hope) · 2017Article
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
Abstract
objectiveWe investigated the association between crowding as measured by ambulance diversion and differences in access, treatment and outcomes between black and white patients.
designRetrospective analysis.
settingWe 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.
participants29,939 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).
resultsHospitals 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.
conclusionsHospitals 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.
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