Research project explores disparities in hospital patient transfers

Each year, one in five Americans visits the emergency department, and approximately 3 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’s principal investigator, Charleen Hsuan, assistant professor of health policy and administration at Penn State, the project will build 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. Typically, patients who need emergency treatment can 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.

Douglas Leslie, professor and vice chair for education in the Department of Public Health Sciences, and Dr. Eleanor Dunham, assistant professor of emergency medicine, both of Penn State College of Medicine, are contributing to the project.

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.

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