A Conceptual Framework for Optimizing the Equity of Hospital‐Based Emergency Care: The Structure of Hospital Transfer Networks

Abstract

r Current pay-for-performance and other payment policies ignore hospital transfers for emergency conditions, which may exacerbate disparities.r No conceptual framework currently exists that offers a patientcentered, population-based perspective for the structure of hospital transfer networks.r The hospital transfer network equity-quality framework highlights the external and internal factors that determine the structure of hospital transfer networks, including structural inequity and racism.Context: Emergency care includes two key components: initial stabilization and transfer to a higher level of care. Significant work has focused on ensuring that local facilities can stabilize patients. However, less is understood about transfers for definitive care. To better understand how transfer network structure impacts population health and equity in emergency care, we propose

Racial and ethnic disparities in emergency department transfers to public hospitals

“…The law does not address inequitable access to care, geographic differences in hospital capability [10][11][12][13] and capacity, 5-9 differences in racial disparities in EMS transport to hospitals, 75 and hospitals strategically declaring ambulance diversions. 80 This study underscores the necessity to systematically examine all factors that influence the equity of care 37 and fills in gaps about racial and ethnic differ-…”

“…40 Hospital markets may also influence F I G U R E 1 Application of Hospital Transfer Network Equity-Quality (NET-EQUITY) to the study. This is a revised version of the NET-EQUITY model, which was published in Hsuan (2023) 37 © 2023 The Milbank Memorial Fund.…”

“…To better understand the potential source of racial disparities, we relied on the Hospital Transfer Network Equity–Quality (NET‐EQUITY) conceptual framework, a framework we developed for understanding the equity of hospital transfer networks. 37 NET‐EQUITY suggests that the structure of hospital transfer networks is influenced by internal and external factors. Internal factors include hospital culture, ownership, 14 and provider specialty, training, and experience.…”