Table 2.
Hospital Features Associated with Emergency Medical Treatment and Labor Act (EMTALA) Citation Events
| Observations with a citation* | Adjusted ** | Adjusted Non- 2411 deficiencies*** | Adjusted 2411 deficiencies | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
| ||||||||||
| n(%) | OR | 95 CI% | p-values | OR | 95 CI% | p-values | OR | 95 CI% | p-values | |
| Ownership | ||||||||||
| Government Owned | 298 (3.6%) | |||||||||
| Private not-for-profit | 943 (4.1%) | 1.11 | 0.94, 1.32 | 0.203 | 1.12 | 0.93, 1.34 | 0.234 | 1.10 | 0.74, 0.72 | 0.638 |
| Private for profit | 401 (6.2%) | 1.61 | 1.32, 1.96 | 0.000 | 1.74 | 1.40, 2.16 | 0.000 | 1.14 | 0.72, 1.81 | 0.579 |
| CMS Quality Measures **** | ||||||||||
| AMI 75th Percentile | 64 (2.8%) | 0.74 | 0.56, 0.99 | 0.040 | 0.76 | 0.57, 1.03 | 0.072 | 0.41 | 0.10, 1.64 | 0.210 |
| HF 75th Percentile | 34 (4.1%) | 1.15 | 0.78, 1.68 | 0.484 | 1.15 | 0.76, 1.73 | 0.511 | 1.13 | 0.50, 2.57 | 0.765 |
| PNA 75th Percentile | 13 (3.8%) | 0.86 | 0.42, 1.79 | 0.694 | 0.90 | 0.45, 1.79 | 0.754 | 0.72 | 0.09, 5.48 | 0.754 |
| Hospital Characteristics | ||||||||||
| Critical access hospital | 228 (2.7%) | 1.10 | 0.82, 1.47 | 0.521 | 1.10 | 0.82, 1.49 | 0.519 | 1.00 | ||
| Regional referral center | 122 (5.0%) | 1.01 | 0.81, 1.26 | 0.902 | 0.91 | 0.71, 1.16 | 0.442 | 1.51 | 1.00, 2.27 | 0.051 |
| Indigent care hospital | 280 (4.6%) | 0.95 | 0.79, 1.12 | 0.520 | 0.99 | 0.82, 1.19 | 0.896 | 0.84 | 0.60, 1.17 | 0.299 |
| Teaching hospital | 160 (6.6%) | 1.22 | 0.97, 1.51 | 0.084 | 0.99 | 0.76, 1.29 | 0.945 | 2.19 | 1.49, 3.20 | 0.000 |
| Metropolitan status | 1099 (5.3%) | 1.32 | 1.11, 1.57 | 0.002 | 1.28 | 1.07, 1.54 | 0.009 | 1.60 | 1.04, 2.45 | 0.033 |
| ED Volume (1st Quartile reference) | ||||||||||
| 1st Quartile (smallest) | 256 (2.7%) | |||||||||
| 2nd Quartile | 350 (3.7%) | 1.26 | 0.98, 1.63 | 0.071 | 1.29 | 0.99, 1.67 | 0.055 | 0.73 | 0.29, 1.83 | 0.500 |
| 3rd Quartile | 450 (4.7%) | 1.29 | 0.97, 1.71 | 0.079 | 1.26 | 0.94, 1.68 | 0.128 | 0.99 | 0.39, 2.56 | 0.989 |
| 4th Quartile (largest) | 586 (6.2%) | 1.56 | 1.14, 2.12 | 0.005 | 1.58 | 1.14, 2.19 | 0.005 | 1.00 | 0.37, 2.68 | 0.998 |
| Hospital Size (1st Quartile reference) | ||||||||||
| 1st Quartile (smallest) | 265 (2.8%) | |||||||||
| 2nd Quartile | 333 (3.5%) | 1.03 | 0.80, 1.32 | 0.805 | 0.98 | 0.76, 1.26 | 0.852 | 6.09 | 0.74, 50.00 | 0.092 |
| 3rd Quartile | 432 (4.6%) | 1.21 | 0.93, 1.59 | 0.163 | 1.05 | 0.79, 1.38 | 0.756 | 13.10 | 1.59, 107.73 | 0.017 |
| 4th Quartile (largest) | 612 (6.4%) | 1.48 | 1.09, 1.99 | 0.010 | 1.16 | 0.85, 1.60 | 0.347 | 22.06 | 2.67, 182.55 | 0.004 |
| Medicare Admissions (% of Inpatient Admissions) | 1.00 | 0.99, 1.00 | 0.581 | 1.00 | 0.99, 1.01 | 0.635 | 1.00 | 0.99, 1.01 | 0.934 | |
| Medicaid Admissions (% of Inpatient Admissions) | 1.01 | 1.00, 1.01 | 0.015 | 1.01 | 1.00, 1.01 | 0.033 | 1.01 | 1.00, 1.02 | 0.128 | |
Number of hospital-year observations with an EMTALA citation and percentage of all hospital-year observations in category with a citation
The adjusted model uses contemporaneous ownership category at the hospital-year level
This excludes citation events involving a citation for deficiency 2411 (recipient hospittal responsibilities), these are hospitals where the citation event involved a patient presenting to the same hospital receiving the citation, and not a hospital refusing to accept appropriate transfer of a patient at another ED
This output represents hospitals scoring in the top quartile of quality compared with those not in the top quartile. We additionally controlled for bottom quartile of quality measures compared with not in the bottom quartile, however,no significant relationship between odds of citation and low quality was identified.
Key: CMS: Centers for Medicare & Medicaid Services; AMI: Acute Myocardial Infarction; HF: Heart Failure; PNA; Pneumonia; ED; Emergency Department