A study published last month in part by UT researchers found significant differences between which hospitals white patients and patients of color are taken to by ambulance from emergency scenes within the same ZIP code.

According to the study, the team decided before analysis that more than a 5% difference in the hospital destinations from the same ZIP code would be significant. Using national ambulance transport data from more than 2,000 ZIP codes, three out of five ZIP codes were found to have a difference greater than 5%. In half of all ZIP codes, the difference was more than 8%.

Senior author Lawrence Brown said the researchers do not think their findings reflect explicit decisions made by EMS clinicians to transport white and patients of color to different hospitals. Instead, he said there are underlying systemic drivers that are influencing those decisions.

“Some ZIP codes are geographically quite large, and if there is geographic segregation within a ZIP code, … we might just be seeing geographic differences,” said Brown, a professor in the department of surgery and perioperative care at the Dell Medical School. 

Brown said insurance networks can also be systemic drivers of these differences.

“Insurance is tied to employment,” Brown said. “The extent where white people and Black people and people of other races and ethnicities might work is somehow different, or at least a little bit segregated, that might affect what insurance networks they have access to.” 

Additionally, co-author Remle Crowe said patients are not always transported to the nearest hospital due to a variety of factors such as patient preference and hospital resource availability.

“If you got picked up by an ambulance today … they’ll ask you, ‘Which hospital do you want to go?’” Crowe said. “But let’s say the injury was so severe that the patient can’t communicate, … it’s really a complex decision-making process of getting the patient to the right resources at the right time.”

Crowe said the study highlights the role of prehospital care and delivery in affecting patient outcomes, not only the role of the destination hospital, which is important to factor in when the industry addresses disparities in health care access.

“The solutions that policymakers are developing to address disparities across the health care system need to not forget that ambulance care is part of that system,” Brown said. “We think the same tools that are used to reduce disparities throughout the health care system can also be used to address disparities in where patients are transported.”