National Healthcare Disparities Report - LDI Health Economist

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Timeliness Chapter 4 n Not all patients seeking care in an ED need urgent care, and use of EDs for nonurgent care could lead to longer wait times. The National Hospital Ambulatory Medical Care Survey defines five levels of urgency of ED visits: n Immediate, requiring immediate care. n Emergent, requiring care in less than 15 minutes. n Urgent, requiring care within 1 hour. n Semiurgent, requiring care within 2 hours. n Nonurgent, not requiring care within 2 hours. Figure 4.3. Emergency department visits in which patient had to wait an hour or more by urgency, race, and insurance status, 2008-2009 40 White Black 40 Private Public Uninsured 30 30 Percent 20 Percent 20 10 10 0 Immediate/ Emergent Urgent 0 Immediate/Emergent Urgent Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey (NHAMCS), 2008-2009. Denominator (Immediate or Emergent): Visits to U.S. emergency departments with triage assessments of immediate or emergent. Denominator (Urgent): Visits to U.S. emergency departments with triage assessments of urgent. Note: For this measure, lower rates are better. Race data were missing for 13.3% of total visits included in this chart. Missing race data were imputed. Standard errors were inflated as described at 2007 NHAMCS Microdata File Documentation, ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/. Insurance status shown for patients under age 65 and classified based on all expected payment sources. Public insurance includes Medicare, Medicaid, and State Children’s Health Insurance Program. Uninsured is defined as having “only self-pay” or “no charge/charity” as payment sources. n In 2008-2009, among ED visits for immediate/emergent conditions, there was no statistically significant difference between Whites and Blacks in the percentage who had to wait an hour or more. There were also no statistically significant differences between uninsured patients and patients with private insurance (Figure 4.3). 158 National Healthcare Disparities Report, 2011
Timeliness n Among visits for urgent conditions, the percentage of patients who had to wait an hour or more was higher for Blacks compared with Whites and for uninsured patients under age 65 compared with privately insured patients under age 65. Also, in the NHQR: n In 2008-2009, among ED visits for immediate/emergent conditions, there was no statistically significant difference between patients living in metropolitan and nonmetropolitan areas in the percentage who had to wait an hour or more. Among visits for urgent conditions, the percentage who had to wait an hour or more was lower among nonmetropolitan patients compared with metropolitan patients. Timeliness of Cardiac Reperfusion for Heart Attack Patients The capacity to treat hospital patients in a timely manner is especially important for emergency situations such as heart attacks. Some heart attacks are caused by blood clots. Early actions, such as percutaneous coronary intervention (PCI) or fibrinolytic medication, may open blockages caused by blood clots, reduce heart muscle damage, and save lives (Kloner & Rezkalla, 2004). To be effective, these actions need to be performed quickly after the start of a heart attack. Chapter 4 In this report, we present two measures of timeliness of cardiac reperfusion: n PCI within 90 minutes among appropriate patients. n Fibrinolytic medication within 30 minutes among appropriate patients. Figure 4.4. Hospital patients with heart attack who received percutaneous coronary intervention within 90 minutes, by race/ethnicity, 2005-2009 100 White Black Hispanic Asian 2008 Achievable Benchmark: 91% AI/AN 80 60 Percent 40 20 0 2005 2006 2007 2008 2009 Key: AI/AN = American Indian or Alaska Native. Source: Centers for Medicare & Medicaid Services, Medicare Quality Improvement Organization Program, 2005-2009. Denominator: Patients hospitalized with a principal diagnosis of acute myocardial infarction who were appropriate candidates for percutaneous coronary intervention. Note: Data were insufficient for this analysis for Native Hawaiians and Other Pacific Islanders. National Healthcare Disparities Report, 2011 159
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U.S. Department of Health and Human
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