Disparities in Emergency Department Quality of Care among Patients with and without Coronary Heart Disease Diagnoses
- Author(s): Sammartinova, Jitka
- Advisor(s): Glik, Deborah C
- et al.
This study investigated predictors of emergency department quality of care using the indicator of wait time to see a health care provider. Prior evidence shows that quality of care may vary by patient characteristics, with poorer outcomes among women and minority populations. Given as well the burden of acute coronary syndrome and the need to treat it quickly, the aim of this work was to study whether the amount of time patients waited in the emergency department varied by patient characteristics, with specific attention to patient gender and presenting with symptoms of coronary heart disease. Primary research hypotheses tested whether women and patients with minority population status had longer wait times compared to men and non-minority patients, while controlling for the contextual factors related to the patient visit. Study research questions were addressed using a large-scale population-based survey, the Emergency Department dataset of the National Hospital Ambulatory Medical Care Survey collected in 2008. Predictors of emergency department wait time were selected based on prior research. Development of the conceptual model that guided the study analysis applied the theoretical perspective of social stratification with focus on health disparities.
Study findings revealed that the length of time patients must wait to see a physician in a hospital emergency department can be predicted from a cluster of factors descriptive of the patient visit. In general, patient wait time is associated with the situational nature of the visit, structural characteristics of the hospital, as well as the characteristics of the patients themselves. Patients who wait a longer time are more likely to be women, African American, and poor. Among patients with coronary heart disease diagnoses at the time of visit to the emergency department, the amount of time people wait is associated with situational characteristics of the patient visit, and structural characteristics of the hospital, but patient sociodemographic characteristics are not significant predictors.
Among patients in general longer emergency department wait time for women patients, African American patients and the poor could indicate systematic biases and lower quality of care. However, when considering the specific context of seeking care among patients with coronary heart disease diagnoses, no significant gender differentials in wait time were found.