Evidence map›Paper›PMID 38229568›Full record

ArticleHealth services research2024

Racial and ethnic disparities in emergency department transfers to public hospitals.

Charleen Hsuan, David J Vanness, Alexis Zebrowski, Brendan G Carr, Edward C Norton, David G Buckler, Yinan Wang, Douglas L Leslie, Eleanor F Dunham, Jeannette A Rogowski

Abstract read
In one paragraph

Article in Health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Observational
  2. Alternative Approaches to Characterizing Disparate Care by Race, Ethnicity, and Insurance Between Hospitals.International journal of environmental research and public health · 2025
    Article
  3. Article
  4. Article
  5. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Charleen HsuanDepartment of Health Policy & Administration, Pennsylvania State University, State College, Pennsylvania, USA.ORCID 0000-0001-8720-2323
David J VannessDepartment of Health Policy & Administration, Pennsylvania State University, State College, Pennsylvania, USA.ORCID 0000-0002-9790-2988
Alexis ZebrowskiDepartment of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Brendan G CarrDepartment of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Edward C NortonDepartment of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.ORCID 0000-0003-4555-0631
David G BucklerDepartment of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.ORCID 0000-0002-6018-8282
Yinan WangDepartment of Health Policy & Administration, Pennsylvania State University, State College, Pennsylvania, USA.
Douglas L LeslieDepartment of Public Health Sciences, College of Medicine, Pennsylvania State University, State College, Pennsylvania, USA.ORCID 0000-0001-6145-4610
Eleanor F DunhamDepartment of Emergency Medicine, College of Medicine, Pennsylvania State University, State College, Pennsylvania, USA.ORCID 0000-0003-2369-1724
Jeannette A RogowskiDepartment of Health Policy & Administration, Pennsylvania State University, State College, Pennsylvania, USA.

Funding

Penn State Clinical and Translational Science InstituteUL1TR002014 · NCATS · PENNSYLVANIA STATE UNIV HERSHEY MED CTR · PI KRASCHNEWSKI, JENNIFER L. · 2016 to 2025
$33.7M
Structural Racism and Discrimination in Emergency Department Transfers: Unintended Consequences of the Emergency Medical Treatment and Labor Act (EMTALA)R01MD017495 · NIMHD · PENNSYLVANIA STATE UNIVERSITY, THE · PI CHARLEEN HSUAN · 2022 to 2026
$3.3M
NCATS NIH HHS UL1 TR002014NIMHD NIH HHS R01 MD017495NIMHD NIH HHS R01MD017495
6 · The paper itself

Abstract

objectiveTo examine racial/ethnic differences in emergency department (ED) transfers to public hospitals and factors explaining these differences. DATA SOURCES AND STUDY

settingED and inpatient data from the Healthcare Cost and Utilization Project for Florida (2010-2019); American Hospital Association Annual Survey (2009-2018). STUDY

designLogistic regression examined race/ethnicity and payer on the likelihood of transfer to a public hospital among transferred ED patients. The base model was controlled for patient and hospital characteristics and year fixed effects. Models II and III added urbanicity and hospital referral region (HRR), respectively. Model IV used hospital fixed effects, which compares patients within the same hospital. Models V and VI stratified Model IV by payer and condition, respectively. Conditions were classified as emergency care sensitive conditions (ECSCs), where transfer is protocolized, and non-ECSCs. We reported marginal effects at the means. DATA COLLECTION/EXTRACTION

methodsWe examined 1,265,588 adult ED patients transferred from 187 hospitals. PRINCIPAL

findingsBlack patients were more likely to be transferred to public hospitals compared with White patients in all models except ECSC patients within the same initial hospital (except trauma). Black patients were 0.5-1.3 percentage points (pp) more likely to be transferred to public hospitals than White patients in the same hospital with the same payer. In the base model, Hispanic patients were more likely to be transferred to public hospitals compared with White patients, but this difference reversed after controlling for HRR. Hispanic patients were - 0.6 pp to -1.2 pp less likely to be transferred to public hospitals than White patients in the same hospital with the same payer.

conclusionsLarge population-level differences in whether ED patients of different races/ethnicities were transferred to public hospitals were largely explained by hospital market and the initial hospital, suggesting that they may play a larger role in explaining differences in transfer to public hospitals, compared with other external factors.

Indexed as

Black or African AmericanEthnicityAdultEmergency Service, HospitalHealthcare DisparitiesHispanic or LatinoHospitals, PublicHumansUnited StatesWhitedisparitiesemergency departmentspublic hospitalrace and ethnicitytransfers

Identifiers

PMID38229568
PMCPMC10915485

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.