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DOI: 10.1055/s-0041-1736439
A Retrospective Study of Disparities in an Academic Ophthalmic Emergency Department
Funding There was no government or non-government support for this paper.
Abstract
Purpose Emergency medicine is a common access point to health care; disparities in this care by demographic characteristics, including race and ethnicity, may affect outcomes. The Massachusetts Eye and Ear (MEE) Emergency Department (ED) is a subspecialty emergency department; data from this site can be utilized to better understand social determinants of quality ophthalmic care.
Design This is a retrospective cross sectional cohort study in the MEE ED examining patient visits from June 1, 2016 to June 30, 2019.
Methods Using the electronic medical record system, all unique visits were identified between June 1, 2016 and June 30, 2019 (inclusive); patient demographics (sex, race, ethnicity [Hispanic vs. non-Hispanic], primary care provider [PCP] status, insurance type, zip code, primary language), date of visit, triage category and outcomes (final diagnosis, visit duration, and next visit at MEE within 3 months of the ED visit) were collected. Kaplan-Meier plots were used to visualize likelihood of follow-up visit to MEE for urgent patients based on demographics. Multivariate linear regression was used to examine factors affecting visit durations, as stratified by urgency, and Cox proportional hazards regression was used to establish hazard ratios for next visit to MEE.
Results Of the 46,248 ophthalmology ED initial visits, only triage status, season of visit, out-of-state residency, Medicare coverage, and Medicaid coverage led to statistically significant differences in visit durations for urgent visits compared with the respective reference groups. Similar trends persisted within the non-urgent visit cohort for visit durations. Residency, insurance coverage, season of visit, race, PCP status, and sex were identified as statistically significant predictors of the likelihood of a follow-up visit.
Conclusion Data from an ophthalmic emergency department suggest that demographic factors do impact patient visit duration and time to follow-up visit. These findings suggest a continued need for attention to social determinants of health and equitable care of patients within ophthalmology.
Financial Disclosures
None.
Publikationsverlauf
Eingereicht: 05. Mai 2021
Angenommen: 05. August 2021
Artikel online veröffentlicht:
25. Dezember 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Hooker EA, Mallow PJ, Oglesby MM. Characteristics and trends of emergency department visits in the United States (2010-2014). J Emerg Med 2019; 56 (03) 344-351
- 2 National Hospital Ambulatory Medical Care Survey: 2017 Emergency Department Summary Tables. Published online 2017:37 accessed on March 3, 2021 at: cdc.gov/nchs/data/nnames/web-tables/2017_ed_web_tables-508.pdf
- 3 Levine DM, Linder JA, Landon BE. Characteristics of Americans with primary care and changes over time, 2002-2015. JAMA Intern Med 2020; 180 (03) 463-466
- 4 Barish RA, McGauly PL, Arnold TC. Emergency room crowding: a marker of hospital health. Trans Am Clin Climatol Assoc 2012; 123: 304-310 , discussion 310–311
- 5 Enard KR, Ganelin DM. Exploring the value proposition of primary care for safety-net patients who utilize emergency departments to address unmet needs. J Prim Care Community Health 2017; 8 (04) 285-293
- 6 Durand AC, Gentile S, Devictor B. et al. ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. Am J Emerg Med 2011; 29 (03) 333-345
- 7 Doran KM, Raven MC, Rosenheck RA. What drives frequent emergency department use in an integrated health system? National data from the Veterans Health Administration. Ann Emerg Med 2013; 62 (02) 151-159
- 8 LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 2010; 56 (01) 42-48
- 9 Pulse Reports for the Emergency Department. 2011 Press Ganey Pulse Report. Press Ganey. Updated 2011. Accessed March 2021 at: https://helpandtraining.pressganey.com/Documents_secure/Pulse%20Reports/2011_Press_Ganey_Pulse_Report.pdf
- 10 Wilper AP, Woolhandler S, Lasser KE. et al. Waits to see an emergency department physician: U.S. trends and predictors, 1997-2004. Health Aff (Millwood) 2008; 27 (02) w84-w95
- 11 Horwitz LI, Green J, Bradley EH. US emergency department performance on wait time and length of visit. Ann Emerg Med 2010; 55 (02) 133-141
- 12 Dehon E, Weiss N, Jones J, Faulconer W, Hinton E, Sterling S. A systematic review of the impact of physician implicit racial bias on clinical decision making. Acad Emerg Med 2017; 24 (08) 895-904
- 13 Qiao WP, Powell ES, Witte MP, Zelder MR. Relationship between racial disparities in ED wait times and illness severity. Am J Emerg Med 2016; 34 (01) 10-15
- 14 Chang DC, Britt LD, Cornwell EE. Racial disparities in emergency surgical care. Med Clin North Am 2005; 89 (05) 945-948 , 947
- 15 James CA, Bourgeois FT, Shannon MW. Association of race/ethnicity with emergency department wait times. Pediatrics 2005; 115 (03) e310-e315
- 16 Bazarian JJ, Pope C, McClung J, Cheng YT, Flesher W. Ethnic and racial disparities in emergency department care for mild traumatic brain injury. Acad Emerg Med 2003; 10 (11) 1209-1217
- 17 DeVon HA, Burke LA, Nelson H, Zerwic JJ, Riley B. Disparities in patients presenting to the emergency department with potential acute coronary syndrome: it matters if you are Black or White. Heart Lung 2014; 43 (04) 270-277
- 18 López L, Wilper AP, Cervantes MC, Betancourt JR, Green AR. Racial and sex differences in emergency department triage assessment and test ordering for chest pain, 1997-2006. Acad Emerg Med 2010; 17 (08) 801-808
- 19 Park CY, Lee MA, Epstein AJ. Variation in emergency department wait times for children by race/ethnicity and payment source. Health Serv Res 2009; 44 (06) 2022-2039
- 20 Pines JM, Russell Localio A, Hollander JE. Racial disparities in emergency department length of stay for admitted patients in the United States. Acad Emerg Med 2009; 16 (05) 403-410
- 21 Massachusetts Eye and Ear Quality and Outcomes. Department of Ophthalmology, 2020. Accessed on March 14, 2021 at: https://www.masseyeandear.org/assets/MEE/pdfs/about/2020-Quality-Outcomes-Ophthalmology-Report.pdf
- 22 Akaike H. Information theory and an extension of the maximum likelihood principle. In: Petrov BN, Csaki BF. eds. Paper presented at: Second International Symposium on Information Theory. Academiai Kiado; 1973: 267-281
- 23 Lagakos SW, Schoenfeld DA. Properties of proportional-hazards score tests under misspecified regression models. Biometrics 1984; 40 (04) 1037-1048
- 24 Lin DY, Wei LJ. The robust inference for the cox proportional hazards model. J Am Stat Assoc 1989; 84 (408) 1074-1078
- 25 QuickFacts. Massachusetts. United States Census Bureau website. Updated July 1, 2019. Accessed March 2021 at: https://www.census.gov/quickfacts/MA