title: The complex association of race and leaving the pediatric emergency department without being seen by a physician.
abstract: OBJECTIVE
  This study examined the influence of race and language on leaving the emergency department (ED) without complete evaluation and treatment (LWCET).
  
  
  METHODS
  This retrospective, case-cohort study examined LWCET among patients discharged home from 2 EDs between March 2, 2009, and March 31, 2010. Race and language were obtained by family self-report. We also explored wait time to see a physician as an explanation of racial disparities.
  
  
  RESULTS
  One thousand two hundred eighty-five (1.7%) of 76,931 ED encounters ended in LWCET. Factors increasing LWCET were high ED activity, low acuity, and medical assistance (MA) insurance. American Indian, biracial, African American, and Hispanic races were also associated with higher odds of LWCET among visits by MA insurance patients compared with those of white patients on private insurance. Restricting the analysis to visits by MA insurance patients, only American Indian race was associated with LWCET compared with white race. Visits by patients using an interpreter or speaking a language other than English at home had lower odds of ending in LWCET. Sensitivity analyses in subgroups confirmed these findings. We developed a measure of ED activity that correlated well with wait time to see a physician (correlation coefficient = 0.993; P < 0.001). Among non-LWCET visits, wait time to see a practitioner did not correlate with racial disparities in LWCET.
  
  
  CONCLUSIONS
  Race, language, and insurance status interact to form a complex relationship with LWCET. Medical assistance insurance status appears to account for much of the excessive instances of LWCET seen in nonwhites. After restricting the analysis to MA insurance patients, only visits by American Indian patients had higher odds of LWCET compared with whites on MA insurance. Wait time to see a physician did not explain racial differences in LWCET.
authors.affiliation: Departments of Quality and Safety, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
authors.forename: Blair
authors.initials: B
authors.lastname: Harrison
authors.forename: Marsha
authors.initials: M
authors.lastname: Finkelstein
authors.forename: Susan
authors.initials: S
authors.lastname: Puumala
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Payne
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D007802:Language; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010820:Physicians; D044469:Racial Groups; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists