Researchers recently looked at data from more than 91,000 patients who were admitted to hospitals in California with the diagnosis of a heart attack between the years of 2001 and 2011. The study did not find a meaningful difference in the rates of survival one year out between races when the hospital was not experiencing overcrowding or was only on diversion for six hours or less on the date the patient presented to the ER with AMI symptoms. However, when hospitals diverted ambulances for longer periods of time, African American patients were more likely to suffer death during the first year after their heart attack, the retrospective study found. The study was reported in the Journal of Health Affairs.
“Black patients still fared worse compared to white patients even though both experienced the same level of diversion, had the same access to technology, received the same measurable treatment, and were treated in similar hospitals,” said lead study author Dr. Renee Hsia, an emergency physician at Zuckerberg San Francisco General Hospital and Trauma Center.
The Problem with Diversion
Ambulances are diverted when an ER becomes too crowded, or a hospital experiences an influx of patient admissions that threaten their capacity. The goal is always to send patients to hospitals where they can receive prompt attention. The problem is that the nearest hospital is usually several minutes to a few hours away, by ambulance. This leaves many in a precarious situation.
The study found a larger percentage of African American patients were regularly diverted, presumably due to chronic overcrowding in urban hospitals as opposed to rural or suburban hospitals.
- 48 percent of white patients were diverted
- 52 percent of black patients were diverted
Furthermore, when black patients suffered a heart attack on a day that the hospital nearest them was on diversion for 6 -12 hours, their odds of dying within the first year increased by 4.1 percentage points over white patients. When the diversion for the hospital lasted 12 hours or more African American patients showed close to a 19 percent increase in risk relative to Caucasian patients, the study authors pointed out.
Missing Data: Arrival Methods
One item was glaringly missing from the study: patient arrival methods. Is it possible that African American patients are traveling to urban hospitals from nearby neighborhoods, arrived by car instead of an ambulance? Perhaps this could account for some of the unexplained disparity. When an ER is on diversion, ambulance companies are made aware immediately. However, patients arriving by car may not be aware of the overcrowding issue, causing an increase in the time from door to the cath lab in the case of AMI.
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