System-Level Health Disparities in California Emergency Departments: Minorities and Medicaid Patients Are at Higher Risk of Losing Their Emergency Departments

Abstract

Study Objective Emergency Department (ED) closures threaten community access to emergency services, but few data exist to describe factors associated with closure. We evaluated factors associated with ED closure in California and sought to determine if hospitals serving more vulnerable populations have a higher rate of ED closure. Methods Retrospective cohort study of California hospital EDs between 1998 and 2008, using hospital and patient level data from the California Office of Statewide Planning and Development (OSHPD), as well as OSHPD Patient Discharge Data. We examined the effects of hospital and patient factors on the hospital's likelihood of ED closure using Cox proportional hazards models. Results In 4,411 hospital-years of observation, 29 of 401 (7.2%) EDs closed. In a model adjusted for total ED visits, hospital discharges, trauma center and teaching status, ownership, operating margin, and urbanicity, hospitals with more black patients (OR 1.41 per increase in proportion of blacks by 0.1, 95% CI 1.16-1.72) and Medi-Cal recipients (OR 1.17 per increase in proportion insured by Medi-Cal by 0.1, 95% CI 1.02-1.34) had higher odds for ED closure, as did for-profit institutions (OR 1.65, 95% CI 1.13-2.41). Conclusion The population served by EDs and hospitals’ profit model are associated with ED closure. Whether our findings are a manifestation of poorer reimbursement in at-risk EDs is unclear.

Insurance status is a predictor of failure to rescue in trauma patients at both safety net and non–safety net hospitals

“…15,16 Unlike other patient-level factors such as age and race, insurance status of patients has a direct effect on trauma centers' financial viability. 17,18 A hospital's financial standing influences its quality of care by providing the means for increased staffing levels, newer technology, and more active quality improvement programs. 19Y22 Because of this, it is plausible that hospitals with a disproportionate share of uninsured patients, that is, safety net hospitals, could have more adverse outcomes overall.…”

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

“…However, these results are similar to those found in studies of other states, which demonstrate that hospital closures differentially affect vulnerable populations. [33][34][35] In addition, a comprehensive study of factors associated with ED closures in the United States has shown that EDs are more likely to close if they are characterized by for-profit ownership, location in a competitive market, safety net status, and low profit margin when fully adjusting for other factors. 4 This study also demonstrates that spatial analysis can be used to predict changes in ED volume related to hospital closures.…”

Health disparities in Chinese Americans with hypertension: A review

“…Several environmental factors, including residential location, hazards and pollutants, have been implicated in racial and ethnic health disparities in hypertension [9,24,25]. For example, older Chinese Americans who live in urban areas have more healthcare resources than those who live in rural areas [19].…”