An Analysis Of The Multi-Level Factors That Impact Provision Of Emergency Medical Services To Hispanic Older Adults

Project Summary/Abstract Hispanics are one of the fastest growing populations of older adults in the United States (U.S.). From 2019 to 2060, the population of Hispanic older adults aged 65 years and over in the U.S. is projected to increase from 9% to 21%. Existing literature suggests that Hispanic older adults experience health disparities across multiple sectors of the U.S. healthcare system, including emergency medicine. Emergency medical services (EMS) provided in the prehospital setting, however, are a largely understudied sector in the U.S. healthcare system, especially in the context of Hispanic older adults. EMS serve as an important entry point into the U.S. healthcare system for Hispanic older adults who often have challenges accessing preventive and diagnostic care. The objectives of the proposed dissertation are three-fold: 1) assess the individual, neighborhood, and structural-level factors that impact the provision of EMS care by emergency medical technicians and paramedics to Hispanic older adults; 2) examine the individual and neighborhood-level factors that impact the provision of EMS to Hispanic older adults experiencing a high-acuity, time sensitive, cardiac-related 9-1-1 emergency; and 3) determine the individual and neighborhood-level factors that impact the provision of EMS for Hispanic older adults experiencing a psychiatric-related 9-1-1 emergency, a type of call often triaged as low acuity. The National Institute of Aging’s Health Disparities Framework provides the theoretical foundation for the three studies that comprise this dissertation. The first study in this dissertation is a systematic literature review, an increasingly important approach to synthesize existing literature and provide justification for future research. The second and third studies use data from three sources, including the San Francisco Department of Emergency Management, San Francisco Department of Public Health, and the 2020 and 2021 American Community Survey. The PRISMA 2020 guidelines and Covidence software inform the completion of the systematic literature review, which addresses the first objective. Logistic regression and multilevel modeling are used to: 1) examine the association between individual and neighborhood-level factors and high- acuity, cardiac-related 9-1-1 emergency calls, which address the second objective; and 2) assess the association between individual and neighborhood-level factors with low-acuity, psychiatric-related 9-1-1 emergency calls, which address the third objective. Neighborhood in the second and third objectives refers to ZIP code as the level of geospatial analysis. Stata 17.0 and R are used to run the statistical analyses in the second and third studies. The proposed dissertation will offer insights on the provision of EMS to Hispanic older adults. The findings from this dissertation can inform ongoing efforts to make the EMS system more accessible, age-friendly, and equitable.