Health status disparities among public and private emergency department patients

Objective: To explore whether patients in a public ED had poorer health tha n patients in a private ED, the authors compared the physical and mental he alth statuses of patients seeking emergency care. Methods: A cross-sectiona l observational study of all adult patients, regardless of acuity, seen dur ing two 24-hour periods in spring 1997 in an urban county trauma center (68 ,000 annual visits) and a private community ED (35,000 annual visits). Scor es on the Physical Component Summary (PCS) and the Mental Component Summary (MCS) scales of the Medical Outcomes Study 12-Item Short-Form Health Surve y (SF-12) were compared between sites, with published national norms, and w ith hospital admission. Results: Of 571 eligible patients, 392 (69%) comple ted the SF-12. Patients in the public ED had a mean PCS score of 40.1, comp ared with 43.7 for patients in the private ED, for a difference of 3.6 poin ts (p < 0.01; 95% CI = 0.9 to 6.1). After controlling for age, sex, ethnici ty, triage acuity, ambulance arrival, and insurance status, this difference increased to 3.9 points (p = 0.02; 95% CI = 0.7 to 7.0). The mean MCS scor e among public ED patients was 44.1, compared with 46.5 in the private ED p opulation, for a difference of 2.4 (p = 0.08; 95% CI = -0.3 to 5.0); after adjustment this difference increased to 2.5 (p = 0.15; 95% CI = -0.9 to 5.8 ), but remained statistically not significant. While all scores were signif icantly lower than national norms (mean PCS 50.1, mean MCS 50.0), patients in the public ED scored consistently lowest. PCS score was significantly in versely correlated with admission, with each point decrease in PCS score in creasing the odds of admission by 0.05 (95% CI = 0.01 to 0.08), and conferr ing an odds ratio of 5.1 (95% CI = 1.2 to 21.1) for admission among the 25t h percentile for PCS scores. Conclusions: Patients seeking care in the publ ic ED had lower adjusted physical health status scores than comparable pati ents obtaining care in a private ED. The SF-12 is sufficiently responsive t o detect hypothesized differences between ED populations, and correlates we ll with admission decisions.