title: Ethnic Disparities in Emergency Severity Index Scores among U.S. Veteran's Affairs Emergency Department Patients.
abstract: BACKGROUND
  The goal of these analyses was to determine whether there were systematic differences in Emergency Severity Index (ESI) scores, which are intended to determine priority of treatment and anticipate resource needs, across categories of race and ethnicity, after accounting for patient-presenting vital signs and examiner characteristics, and whether these differences varied among male and female Veterans Affairs (VA) ED patients.
  
  
  RESULTS
  We used a large national database of electronic medical records of ED patients from twenty-two U.S. Department of Veterans Affairs ED stations to determine whether ESI assignments differ systematically by race or ethnicity. Multi-level, random effects linear modeling was used to control for demographic characteristics and patient's vital signs (heart rate, respiratory rate, and pain level), as well as age, gender, and experience of triage nurses. The dataset included 129,991 VA patients presenting for emergency care between 2008 and 2012 (91% males; 61% non-Hispanic White, 28% Black, 7% Hispanic, 2% Asian, <1% American Indian/Alaska Native, 1% mixed ethnicity) and 774 nurses for a total of 359,642 patient/examiner encounters. Approximately 13% of the variance in ESI scores was due to patient characteristics and 21% was due to the nurse characteristics. After controlling for characteristics of nurses and patients, Black patients were assigned less urgent ESI scores than White patients, and this effect was more prominent for Black males compared with Black females. A similar interaction was found for Hispanic males. It remains unclear how these results may generalize to EDs and patient populations outside of the U.S. VA Health Care system.
  
  
  CONCLUSIONS
  The findings suggest the possibility that subgroups of VA patients receive different ESI ratings in triage, which may have cascading, downstream consequences for patient treatment quality, satisfaction with care, and trust in the health equity of emergency care.
authors.affiliation: University of New Mexico, Albuquerque, New Mexico, United States of America.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Vigil
authors.affiliation: University of New Mexico, Albuquerque, New Mexico, United States of America.
authors.forename: Joe
authors.initials: J
authors.lastname: Alcock
authors.affiliation: University of New Mexico, Albuquerque, New Mexico, United States of America.
authors.forename: Patrick
authors.initials: P
authors.lastname: Coulombe
authors.affiliation: University of New Mexico, Albuquerque, New Mexico, United States of America.
authors.forename: Laurie
authors.initials: L
authors.lastname: McPherson
authors.affiliation: University of New Mexico, Albuquerque, New Mexico, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Parshall
authors.affiliation: New Mexico Veterans Affairs Health Center, Albuquerque, New Mexico, United States of America.
authors.forename: Allison
authors.initials: A
authors.lastname: Murata
authors.affiliation: New Mexico Veterans Affairs Health Center, Albuquerque, New Mexico, United States of America.
authors.forename: Heather
authors.initials: H
authors.lastname: Brislen
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014218:Triage / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D044465:White People