Analysis of Consistency in Emergency Department Physician Variation in Propensity for Admission Across Patient Sociodemographic Groups

Abstract

Key Points Question Are physician propensities to admit patients from the emergency department consistent across patient sociodemographic groups? Findings In this cross-sectional analysis of Medicare claims data from 2016 to 2019, the mean adjusted rates of hospital admission from the emergency department differed by patient sex, race and ethnicity, and Medicaid status. Individual physicians varied substantially within hospitals in the percentage of patients they admitted, and these differences in admission propensity were consistent across patient sociodemographic groups. Meaning The findings of this study suggest that physicians with higher or lower propensities to admit patients from the emergency department exhibit their relative propensity consistently across patient sociodemographic groups.

Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure

“…44,45 The concept of SDOH contributing to implicit bias with a subsequent effect on care provision is not new. 16,46,47 However, this is one of the first studies to suggest that low income can contribute to implicit bias. 47 Since income status may not be readily apparent to clinicians, further investigation is needed to better understand whether specific patient attributes or behaviors contribute to the suspected implicit bias observed among adults with low income.…”

Intersection of Structural Racism, Social Determinants of Health, and Implicit Bias With Emergency Physician Admission Tendencies

“…7 In conclusion, this study should be seen as the beginning of the next phase of research into implicit bias in health care, instead of assuming it answers the question of whether implicit bias exists in the health system. 2 The authors are applauded for addressing the issue; however, it is premature to assume implicit bias does not exist in physician admission tendencies given the evidence in the literature to the contrary. In addition, to assume differences in rates of admission are the result of social determinants of health ignores the literature on the role of bias in physician decision-making and the contribution of physician-and hospital-level factors on physician decision-making.…”

“…In conclusion, this study should be seen as the beginning of the next phase of research into implicit bias in health care, instead of assuming it answers the question of whether implicit bias exists in the health system . The authors are applauded for addressing the issue; however, it is premature to assume implicit bias does not exist in physician admission tendencies given the evidence in the literature to the contrary.…”

“…The COVID-19 pandemic exposed the magnitude of influence these factors have on the health of racial and ethnic minority communities, uncovering disparities in how individuals receive care and the outcomes of that care. 1 Khidir and colleagues 2 investigate implicit bias in emergency department (ED) physician admission tendencies by race, ethnicity, sex, and Medicaid enrollment status of patients. Using a 20% random sample of Medicare claims from 2012 through 2015, the authors assessed whether within-hospital physician-level variation in admission rates differed by sociodemographic characteristics of Medicare enrollees and whether there was implicit bias in admission decisions.…”

“… 4 In addition, the study sample was not representative of the typical ED population, excluding younger-aged individuals and frequent ED users. For example, Khidir and colleagues 2 used a Medicare sample, was limited to the 37 most frequent medical diagnoses, and excluded ED visits that occurred within 30 days of a previous visit. Therefore, the conclusions may be different with a more typical ED population.…”