Are there disparities in emergency department clinicians’ consultation of ophthalmologists for management of eye problems?
In this study of medical and billing data from 13 361 eye-related emergency department encounters, approximately three-fifths were managed without consulting the ophthalmology service. Clinicians were significantly less likely to consult an ophthalmologist when patients were black or preferred a non-English language.
The association of patient demographic factors with the decision to involve ophthalmologists in the care of eye problems in the emergency department should be explored in depth.
Nearly 2 million patients visit emergency departments (EDs) because of eye concerns annually in the United States. How hospitals currently assign these patients to treatment is important for designing systems that equitably allocate resources for eye care in urgent settings.
To investigate factors associated with ophthalmology consultation for eye-related adult ED encounters to assess possible disparities by sex, race/ethnicity, language preference, or residential distance from the medical center.
Design, Setting, and Participants
Retrospective observational study of 13 361 adult ED encounters associated with an eye-related billing diagnosis between January 1, 2010, and September 30, 2015, at the University of Michigan Medical Center in Ann Arbor.
Measures available from the University of Michigan clinical data warehouse included age, sex, race/ethnicity, preferred language, home distance from the ED, calendar year of encounter, and Charlson-Deyo Comorbidity Index score.
Main Outcomes and Measures
Association of the ED encounter with ophthalmology consultation. An ophthalmology consultation was identified by cross-referencing ophthalmology faculty and clinical instructors from 2010 to 2015 against billing providers for consultations using the Charlson-Deyo Comorbidity Index score and billing codes. Measures included patient age, sex, race/ethnicity, home address, preferred language (English vs non-English), and calendar year of encounter.
Among the 13 361 encounters, 6840 (51.2%) involved a female patient. Mean (SD) age at encounter was 50.7 (19.3) years; 10 033 patients (75.1%) were of white and 1969 (14.7%) of black race/ethnicity. English was the preferred language for 13 022 patients (97.5%). The ophthalmology service was consulted in 5289 encounters (39.6%). Black patients had significantly lower odds of an ophthalmology consultation than white patients (odds ratio [OR], 0.85; 95% CI, 0.75-0.96). Patients who preferred a non-English language had significantly lower odds of receiving an ophthalmology consultation (OR, 0.73; 95% CI, 0.55-0.98).
Conclusions and Relevance
Many of the 13 361 eye-related ED encounters were managed by ED clinicians with no ophthalmology consultation. Patients who were black or who preferred a language other than English were less likely to have an ophthalmologist involved in their care. The associations found in this observational study do not imply causation but suggest disparities in care that should be further investigated.
Wang SY, Hamid MS, Musch DC, Woodward MA. Utilization of Ophthalmologist Consultation for Emergency Care at a University Hospital. JAMA Ophthalmol. 2018;136(4):428–431. doi:10.1001/jamaophthalmol.2018.0250
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