# Examining the role of insurance in inter-facility transfer for patients with ST-elevation myocardial infarction

> **NIH NIH R21** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2020 · $127,500

## Abstract

PROJECT SUMMARY/ABSTRACT
In the U.S., nearly 500,000 patients suffer an ST-elevation myocardial infarction (STEMI) each year, the
majority of which initially present to emergency departments (EDs). More than 60% of U.S. hospitals do not
have have the capabilities to perform the primary percutaneous coronary intervention (PCI), the preferred
strategy for myocardial reperfusion. Thus, patients must be transferred to capable facilities which are
associated with delays for nearly 90% of patients and worse patient outcomes. Our research team has
identified that insurance status is a key non-medical predictor of increased transfer. Patients with STEMI who
lack insurance presenting to the ED were 60% more likely to be transferred compared with patients
with any form of insurance. Two potential reasons for this finding include uninsured patients presenting to
facilities without PCI capabilities and alternatively, uninsured patients being transferred unnecessarily from
facilities that have PCI capabilities.
The objective of this study is to identify the underlying mechanism resulting in disproportionately higher inter-
facility transfer rates for uninsured patients with STEMI. Whether the uninsured have diminished access to
PCI-capable facilities, or they are transferred from PCI-capable facilities, either explanation has important
policy implications for reducing this disparity in access to optimal management of this time-sensitive
emergency medical condition. We have identified an established dataset, the Office of Statewide Health
Planning and Development (OSHPD) dataset in California which has detailed ED visit data which will allow us
identify the underlying mechanism of higher transfer rates. Combined with important health policy changes
broadening health insurance access including the early expansion of Medi-Cal at the county-level, this
provides an important natural experiment to understand how insurance access affects access to care for time-
sensitive emergencies like STEMI.
This proposal describes an analysis of the existing datasets to understand the mechanism of more patients
with STEMI who lack insurance and are transferred at a much higher rate. The Specific Aims are: 1) Describe
the incidence, longitudinal trends, and transfer status of patients with STEMI presenting to California EDs by
facility PCI capability; 2) Use Medicaid expansion in California to estimate the relationship between insurance
status and transfer of patients presenting to California EDs with STEMI, and assess whether PCI capability
modifies these relationships.
We have assembled a multidisciplinary team of experts in cardiology, emergency medicine, health policy,
health services research, biostatistics, epidemiology, and systems science. We anticipate that the knowledge
gained from this will inform policy makers seeking to understand disparities in care, and to understand whether
insurance expansion is a potential intervention to address these disparities.

## Key facts

- **NIH application ID:** 9969595
- **Project number:** 5R21HL140382-02
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Michael J. Ward
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $127,500
- **Award type:** 5
- **Project period:** 2019-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9969595

## Citation

> US National Institutes of Health, RePORTER application 9969595, Examining the role of insurance in inter-facility transfer for patients with ST-elevation myocardial infarction (5R21HL140382-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9969595. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*