RESUMEN
It is well documented that racial and ethnic minority populations disproportionately use hospital emergency departments for safety-net care. But what is not known is whether emergency department crowding is disproportionately affecting minority populations and potentially aggravating existing health care disparities, including poorer outcomes for minorities. We examined ambulance diversion, a proxy measure for crowding, at 202 California hospitals. We found that hospitals serving large minority populations were more likely to divert ambulances than were hospitals with a lower proportion of minorities, even when controlling for hospital ownership, emergency department capacity, and other hospital demographic and structural factors. These findings suggest that establishing more-uniform criteria to regulate diversion may help reduce disparities in access to emergency care.
Asunto(s)
Ambulancias/estadística & datos numéricos , Hospitales , Grupos Minoritarios/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Adulto , California , Áreas de Influencia de Salud , Aglomeración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Closures of hospital trauma centers have accelerated since 2001. These closures may disproportionately affect disadvantaged communities. We evaluate how driving time between ZIP code areas and the nearest trauma centers-a proxy for access, given the time-sensitive nature of trauma care-changed nationwide during 2001-07. By 2007, sixty-nine million Americans (24 percent of the population) had to travel farther to the nearest trauma center than they did in 2001, and almost sixteen million people had to travel an additional thirty minutes or more. Communities with disproportionately high numbers of African American residents, uninsured people, and people living in poverty, as well as people living in rural areas, were more likely than others to be thus affected. Because mortality from traumatic injuries has also worsened for these vulnerable populations, policy makers should learn more about the possible connections-and consider such measures as paying trauma centers serving these communities higher amounts for treatment of injuries.
Asunto(s)
Accesibilidad a los Servicios de Salud/tendencias , Centros Traumatológicos/tendencias , Poblaciones Vulnerables/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Conducción de Automóvil , Geografía , Disparidades en Atención de Salud , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Modelos Logísticos , Áreas de Pobreza , Servicios de Salud Rural/tendencias , Factores Socioeconómicos , Factores de Tiempo , Estados Unidos , Servicios Urbanos de Salud/tendencias , Población Blanca/estadística & datos numéricosRESUMEN
The presenting symptoms of meningococcemia are protean, and the illness is rapidly progressive and often fatal, making it simultaneously one of the most dangerous and most important illnesses the Emergency Physician can encounter. It attacks the young and it is highly contagious. This report uses one of the many unusual presentations of meningococcemia as a framework for discussing the epidemiology, presentation, diagnosis, and treatment of meningococcal disease.