Analysis of health inequities in transfers of admitted patients from an academic emergency department to partner community hospital

Abstract

BackgroundMany academic medical centers (AMC) transfer patients who require admission but not tertiary care to partner community hospitals from their emergency departments (ED). These transfers alleviate ED boarding but may worsen existing healthcare disparities. We assessed whether disparities exist in the transfer of patients from one AMC ED to a community hospital General Medical Service. MethodsWe performed a retrospective cohort study on all patients screened for transfer between April 1 and December 31, 2021. During the screening process, the treating ED physician determines whether the patient meets standardized clinical criteria and a patient coordinator requests patient consent. We collected patient demographics data from the electronic health record and performed logistic regression at each stage of the transfer process to analyze how individual characteristics impact the odds of proceeding with transfer. Results5558 patients were screened and 596 (11%) ultimately transferred. 1999 (36%) patients were Black or Hispanic, 698 (12%) had a preferred language other than English, and 956 (17%) were on Medicaid or uninsured. A greater proportion of Black and Hispanic patients were deemed eligible for interhospital transfer compared to White patients and a greater proportion of Hispanic patients completed transfer to the community hospital (p < 0.017 after Bonferroni correction). After accounting for other demographic variables, patients older than 50 (OR 1.21, 95% CI 1.04–1.40), with a preferred language other than English (OR 1.27, 95% CI 1.00–1.62), and from a priority neighborhood (OR 1.38, 95% CI 1.18–1.61) were more likely to be eligible for transfer, while patients who were male (OR 1.50, 95% CI 1.10–2.05) and younger than 50 (OR 1.85, 95% CI 1.20–2.78) were more likely to consent to transfer (p < 0.05). ConclusionHealth disparities exist in the screening process for our interfacility transfer program. Further investigation into why these disparities exist and mitigation strategies should be undertaken.