• R A Lowe, S Chhaya, K Nasci, L J Gavin, K Shaw, M L Zwanger, J A Zeccardi, W C Dalsey, S B Abbuhl, H Feldman, and J A Berlin.
• Department of Biostatistics and Epidemiology, University of Pennsylvania Medical Center, and Philadelphia Emergency Medicine Research Consortium, Philadelphia, PA, USA. rlowe@cceb.med.upenn.edu
• Acad Emerg Med. 2001 Mar 1;8(3):259-66.

ObjectiveAfter a pilot study suggested that African American patients enrolled in managed care organizations (MCOs) were more likely than whites to be denied authorization for emergency department (ED) care through gatekeeping, the authors sought to determine the association between ethnicity and denial of authorization in a second, larger study at another hospital.MethodsA retrospective cohort design was used, with adjustment for triage score, age, gender, day and time of arrival at the ED, and type of MCO.ResultsAfrican Americans were more likely to be denied authorization for ED visits by the gatekeepers representing their MCOs even after adjusting for confounders, with an odds ratio of 1.52 (95% CI = 1.18 to 1.94).ConclusionsAfrican Americans were more likely than whites to be denied authorization for ED visits. The observational study design raises the possibility that incomplete control of confounding contributed to or accounted for the association between ethnicity and gatekeeping decisions. Nevertheless, the questions that these findings raise about equity of gatekeeping indicate a need for additional research in this area.

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