Each year, one in five Americans visits the emergency department, and approximately three million of them are transferred to another hospital for a variety of reasons. A $3 million grant from the National Institute on Minority Health and Health Disparities will fund a Penn State-led project to determine if there are disparities in patient transfers.
According to project principal investigator Charleen Hsuan, assistant professor of health policy and administration, the project will construct a unique dataset to study the effects of federal laws on disparities in hospital transfer behavior and help inform policy makers on how to improve laws on transfers for vulnerable patients.
"We already know about 10% of in-hospital deaths are from patients who were transferred, and several studies suggest that some of these deaths may be from the transfer itself," said Hsuan. "Because of these risks, it is critical that hospitals not base transfer decisions on race or economic factors."
The Emergency Medical Treatment and Labor Act (EMTALA) is supposed to prevent hospitals from transferring unstable emergency department patients to other hospitals for discriminatory reasons. EMTALA requires Medicare-participating hospitals to provide emergency care to anyone, regardless of their legal status, race, or ability to pay. Patients who need emergency treatment can usually only be transferred if the benefits of treatment in the second hospital outweigh the risks of transfer.
Even though EMTALA is meant to reduce discrimination, Hsuan theorizes hospitals use the law in unanticipated ways that can reduce quality of care in disadvantaged communities. Hsuan's preliminary research, supported by Penn State's Social Science Research Institute and the Clinical and Translational Science Institute, demonstrates these disparities exist, but the extent of which hospitals systematically transfer economically vulnerable patients is unknown.
Hsuan, who is also a Clinical and Translational Science Institute regulatory impact lead in the Research Methods Core and affiliate law faculty at Penn State Law, explains that with so many different factors influencing how and why patients are transferred, the emergency department environment is very complicated and complex. "I'm really excited to do a deep dive into the data in a much more nuanced way than has ever been done before, because the issue has not been getting enough attention," said Hsuan.
Hsuan and the research team will analyze discharge data from California and New York hospitals to determine if emergency department transfers vary for patients based on race.
Specifically, the project will measure the difference in emergency department stays for minority patients versus white, non-Hispanic transfer patients; assess whether minority patients requiring specialized care are less likely to be transferred to a hospital within the same system; and determine if minority emergency department patients are more likely to be transferred to a safety-net hospital.
"When a patient needs acute care and there are inequities in how that care is distributed and provided, the effects will follow that patient for a very long time," Hsuan said. "Disparities in the emergency department can not only lead to immediate danger to the patient's health, it can also color the way the community sees the health care system.
"EMTALA is an important law and in many cases provides great access to care, but it is not perfect," added Hsuan. "Our hope is this research will make it a stronger law and provide results that can be used to design a more equitable patient transfer system."
Support for preliminary research was provided by seed funding from Penn State's Social Science Research Institute, a CTSI Bridges to Translation Grant, and Penn State's Department of Health Policy and Administration, which supports research as part of the strategic plan of the department.
Other researchers on the project include Jeannette Rogowski, David Vanness, Doug Leslie, and Eleanor Dunham, all from Penn State; Brendan Carr and Alexis Zebrowski, Icahn School of Medicine at Mount Sinai; Renee Hsia, University of California, San Francisco; Ninez Ponce, University of California, Los Angeles; and Michelle Lin, Stanford University.
