A Tale of Two Policies: Qualitative Perspectives on Efforts to Improve Emergency Department-to-Specialty Referrals in the Context of EMTALA and Local Insurance Networks
Abstract/Contents
- Abstract
- The Emergency Medical Treatment and Labor Act (EMTALA) supports a basic minimum access to equitable emergency care for all patients but has led to well-documented unintended consequences including a high financial burden on hospitals and crowding of Emergency Departments. These consequences reach beyond the Emergency Department including affecting hospital capacity. However, it is less well understood how local hospital, regional/state, and insurance network policies impact health equity within the Emergency Department-to-outpatient referral processes. This qualitative study aimed to explore health equity impacts at the intersection of national policy (EMTALA) and local network considerations on Emergency Department-to-specialty referral processes. The context for this work was a quality improvement project piloted between our Emergency and Neurology Departments, which was identified as one of the highest volumes recipient (n = 1069 in 2022) of Emergency Department referrals in our single-site, high volume, academic medical system. We conducted 18 semi-structured interviews with key stakeholders involved in this quality improvement project to specifically explore how policy and insurance network considerations impacted the process. Data were analyzed using rapid matrix analysis and keyword-in-context approaches. Our results found four main themes that represent barriers to equitable healthcare: 1) lack of health insurance and insurance network restrictions thwart people interfacing with the healthcare system: staff, patients, and physicians; 2) mistrust in the healthcare system; 3) inefficient communication between departments; and 4) limited outpatient access capacity. We organized our themes according to Fortney’s five access dimensions model and identified the need for simultaneous initiatives at various dimension levels to improve the issue of access. This work adds to existing literature by determining opportunities for health equity and access improvement in Emergency Department referral processes to specialty departments.
Description
| Type of resource | text |
|---|---|
| Date created | January 1, 2023 - September 1, 2023 |
| Publication date | December 12, 2023; September 1, 2023 |
Creators/Contributors
| Author | Walton, Hannah |
|---|---|
| Thesis advisor | Brown-Johnson, Cati |
| Thesis advisor | Shaw, Jonathan |
| Thesis advisor | Rose, Christian |
| Degree granting institution | Stanford University |
| Department | Department of Medicine |
Subjects
| Subject | Qualitative research |
|---|---|
| Subject | Health equity |
| Subject | Emergency Medical Treatment and Active Labor Act (United States) |
| Subject | Health insurance |
| Subject | Referral processes |
| Genre | Text |
| Genre | Thesis |
Bibliographic information
Access conditions
- Use and reproduction
- User agrees that, where applicable, content will not be used to identify or to otherwise infringe the privacy or confidentiality rights of individuals. Content distributed via the Stanford Digital Repository may be subject to additional license and use restrictions applied by the depositor.
- License
- This work is licensed under a Creative Commons Attribution 4.0 International license (CC BY).
Preferred citation
- Preferred citation
- Walton, H. (2023). A Tale of Two Policies: Qualitative Perspectives on Efforts to Improve Emergency Department-to-Specialty Referrals in the Context of EMTALA and Local Insurance Networks. Stanford Digital Repository. Available at https://purl.stanford.edu/pq755ps9247. https://doi.org/10.25740/pq755ps9247.
Collection
Community Health and Prevention Research (CHPR) Master of Science Theses
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