Table 3 Change in proportion of EMS transports to reference ED associated with Massachusetts AD ban: Sub-groups
Patient cohort | # EMS transports | % EMS transports to reference ED in Massachusetts | % EMS transports to reference ED in comparison states | Unadjusted relative change (percentage points) | Adjusted relative change (percentage points) [95% CI] | p-value | ||||
|---|---|---|---|---|---|---|---|---|---|---|
Pre-ban | Post-ban | % point change | Pre-ban | Post-ban | % point change | |||||
Patient acuity subgroups | ||||||||||
Type of EMS transport | ||||||||||
Advanced Life Saving (ALS) | 213,171 | 68.1% | 67.3% | −0.8 | 61.6% | 63.3% | 1.7 | −2.5 | −2.8 [−4.7, −1.0] | 0.005 |
Basic Life Support (BLS) | 147,835 | 61.7% | 59.7% | −2.0 | 59.5% | 61.3% | 1.8 | −3.8 | −3.2 [−4.9, −1.6] | 0.001 |
Disposition from ED | ||||||||||
Outpatient discharge | 159,135 | 65.2% | 63.8% | −1.4 | 61.7% | 63.8% | 2.1 | −3.5 | −1.7 [− 3.0, −0.3] | 0.02 |
Hospitalization | 201,871 | 65.0% | 63.8% | −1.2 | 60.3% | 61.7% | 1.4 | −2.6 | −3.0 [−4.7, −1.2] | 0.002 |
Hospitalization for a high-risk condition | 69,137 | 65.7% | 63.8% | −1.9 | 61.7% | 62.5% | 0.8 | −2.7 | −2.0 [−4.7, 0.7] | 0.132 |
Geographic factors | ||||||||||
Massachusetts EMS region | ||||||||||
Higher diversion rate regions | 307,618 | 57.3% | 56.9% | −0.4 | 60.9% | 62.7% | 1.8 | −2.2 | −2.9 [−4.4, −1.3] | < 0.001 |
Other regions | 276,780 | 74.5% | 72.5% | −2.0 | 60.9% | 62.7% | 1.8 | −3.8 | −2.5% [−5.8, 0.8] | 0.142 |
# EDs in 3-mile vicinity | ||||||||||
0 or 1 | 267,308 | 70.9% | 68.0% | −2.9 | 63.3% | 65.0% | 1.7 | −4.6 | −2.6 [−4.9, −1.2] | 0.001 |
2 or more | 93,698 | 51.4% | 49.0% | −2.4 | 49.3% | 50.9% | 1.6 | −4.0 | −2.9 [−5.6, −0.2] | 0.037 |
Urban location, % | ||||||||||
Zip code in largest 16 cities | 74,464 | 38.6% | 39.2% | 0.6 | 44.5% | 46.6% | 2.1 | −1.4 | −2.5 [−4.9, −0.3] | 0.032 |
Other zip codes | 286,542 | 69.6% | 67.8% | −1.8 | 63.7% | 65.4% | 1.8 | −3.5 | −2.7 [−4.1, −1.3] | 0.001 |
Socioeconomic status subgroups | ||||||||||
Medicaid (dual) coverage | ||||||||||
With Medicaid coverage | 153,522 | 61.7% | 61.7% | 0.0 | 56.9% | 57.6% | 0.7 | −0.7 | −1.8 [−3.83–0.3] | 0.022 |
Without Medicaid coverage | 207,484 | 66.6% | 64.7% | −1.9 | 62.3% | 64.6% | 2.3 | −4.2 | −3.6 [−6.0, −2.1] | < 0.001 |
Zip code poverty rate | ||||||||||
Lowest poverty tertile | 112,254 | 65.0% | 64.2% | −0.8 | 62.9% | 64.8% | 1.9 | −2.7 | −2.8 [−5.4, − 0.1] | 0.04 |
Middle poverty tertile | 98,335 | 71.8% | 69.7% | −2.1 | 63.4% | 63.5% | 0.1 | −2.2 | −3.0 [−5.5, −0.5] | 0.023 |
Highest poverty tertile | 150,361 | 60.1% | 58.6% | −1.5 | 56.4% | 59.5% | 3.1 | −4.6 | −2.7 [−4.2, − 1.1] | 0.002 |
Zip codes with > 25% census population black, % | 69,383 | 42.6% | 41.3% | −1.3 | 52.5% | 54.7% | 2.1 | −3.4 | −1.3 [−4.0, 1.3] | 0.297 |
Zip codes with > 25% census population Hispanic, % | 111,757 | 67.2% | 65.7% | −1.5 | 57.6% | 58.8% | 1.2 | −2.7 | −4.0 [−5.2, − 2.8] | < 0.001 |