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<!DOCTYPE html>
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta charset="utf-8">
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta name="generator" content="pandoc" />
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white-space: pre;
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vertical-align: middle;
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<h1 id="analysis">Analysis</h1>
<p>Rachel Gold 2022-07-12</p>
<h2 id="r-markdown">R Markdown</h2>
<p>The purpose of this markdown is to analyze CMS Hospital Survey
Deficiencies that we’ve already filtered down to EMTALA violations
involving pregnant patients.</p>
<div class="sourceCode" id="cb1"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb1-1"><a href="#cb1-1" tabindex="-1"></a><span class="fu">library</span>(readxl)</span>
<span id="cb1-2"><a href="#cb1-2" tabindex="-1"></a><span class="fu">library</span>(dplyr)</span></code></pre></div>
<pre><code>##
## Attaching package: 'dplyr'
## The following objects are masked from 'package:stats':
##
## filter, lag
## The following objects are masked from 'package:base':
##
## intersect, setdiff, setequal, union</code></pre>
<div class="sourceCode" id="cb3"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb3-1"><a href="#cb3-1" tabindex="-1"></a><span class="fu">library</span>(stringr)</span>
<span id="cb3-2"><a href="#cb3-2" tabindex="-1"></a><span class="fu">library</span>(writexl)</span>
<span id="cb3-3"><a href="#cb3-3" tabindex="-1"></a><span class="fu">library</span>(readr)</span></code></pre></div>
<h2 id="data">Data</h2>
<p>Reading in violations from 2011-Q3 2022 that we automatically
filtered by features of the inspection_text field (0_etl, 1_etl, and
2_etl). These were then manually reviewed by Rachel Gold and Karen
Rodriguez for whether they, in fact, pertained to pregnant patients.</p>
<div class="sourceCode" id="cb4"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb4-1"><a href="#cb4-1" tabindex="-1"></a>emtala_pregnant <span class="ot"><-</span> <span class="fu">read_xlsx</span>(<span class="st">"data/manual/confirmed_pregnant.xlsx"</span>)</span>
<span id="cb4-2"><a href="#cb4-2" tabindex="-1"></a>emtala_all <span class="ot"><-</span> <span class="fu">read_xlsx</span>(<span class="st">"data/processed/0_etl_all_emtala_deficiencies.xlsx"</span>)</span></code></pre></div>
<h2 id="hospital-counts-features">Hospital counts, features</h2>
<p>Web: “Our investigation found 389 hospitals spanning 44 states have
violated EMTALA statutes while attending to pregnant patients, racking
up at least 683 federal violations since 2011.”</p>
<p>Script: “OUR SCRIPPS NEWS INVESTIGATION FOUND IT IS AMONG 389
HOSPITALS (FC) AROUND THE COUNTRY REPONSIBLE FOR NEARLY 700 VIOLATIONS
OF THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT – OR EMTALA”</p>
<h2 id="violation-count">Violation count</h2>
<p>Web: “racking up at least 683 federal violations since 2011.”</p>
<div class="sourceCode" id="cb5"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb5-1"><a href="#cb5-1" tabindex="-1"></a>facility_count<span class="ot"><-</span><span class="fu">n_distinct</span>(emtala_pregnant<span class="sc">$</span>facility_id)</span>
<span id="cb5-2"><a href="#cb5-2" tabindex="-1"></a></span>
<span id="cb5-3"><a href="#cb5-3" tabindex="-1"></a>violation_count<span class="ot"><-</span><span class="fu">n_distinct</span>(emtala_pregnant<span class="sc">$</span>key_identifier)</span>
<span id="cb5-4"><a href="#cb5-4" tabindex="-1"></a></span>
<span id="cb5-5"><a href="#cb5-5" tabindex="-1"></a>state_count<span class="ot"><-</span><span class="fu">n_distinct</span>(emtala_pregnant<span class="sc">$</span>state)</span>
<span id="cb5-6"><a href="#cb5-6" tabindex="-1"></a></span>
<span id="cb5-7"><a href="#cb5-7" tabindex="-1"></a><span class="fu">print</span>(<span class="fu">paste</span>(<span class="st">"facility_count:"</span>,facility_count,<span class="st">"violation_count:"</span>,violation_count,<span class="st">"state_count:"</span>,state_count))</span></code></pre></div>
<pre><code>## [1] "facility_count: 389 violation_count: 683 state_count: 44"</code></pre>
<div class="sourceCode" id="cb7"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb7-1"><a href="#cb7-1" tabindex="-1"></a>emtala_pregnant<span class="sc">%>%</span></span>
<span id="cb7-2"><a href="#cb7-2" tabindex="-1"></a> <span class="fu">count</span>(state,<span class="at">sort=</span><span class="cn">TRUE</span>)</span></code></pre></div>
<pre><code>## # A tibble: 44 × 2
## state n
## <chr> <int>
## 1 CA 66
## 2 TN 46
## 3 NC 45
## 4 NY 43
## 5 FL 41
## 6 GA 34
## 7 PA 33
## 8 OR 29
## 9 AL 27
## 10 TX 26
## # ℹ 34 more rows</code></pre>
<h2 id="date-range">Date range</h2>
<p>Script:“…ALL INVOLVING PREGNANCY EMERGENCIES BETWEEN 2011 AND
2022.”</p>
<div class="sourceCode" id="cb9"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb9-1"><a href="#cb9-1" tabindex="-1"></a>emtala_pregnant<span class="sc">%>%</span></span>
<span id="cb9-2"><a href="#cb9-2" tabindex="-1"></a> <span class="fu">count</span>(year)</span></code></pre></div>
<pre><code>## # A tibble: 12 × 2
## year n
## <dbl> <int>
## 1 2011 77
## 2 2012 43
## 3 2013 51
## 4 2014 72
## 5 2015 81
## 6 2016 53
## 7 2017 91
## 8 2018 69
## 9 2019 64
## 10 2020 25
## 11 2021 40
## 12 2022 17</code></pre>
<h2 id="percentage-of-emtala-overall">Percentage of EMTALA overall</h2>
<p>Web: “Cases involving pregnant women made up about 15% of all EMTALA
investigations.”</p>
<div class="sourceCode" id="cb11"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb11-1"><a href="#cb11-1" tabindex="-1"></a><span class="co">#number of EMTALA pregnant patient investigations since 2011</span></span>
<span id="cb11-2"><a href="#cb11-2" tabindex="-1"></a>count_preg<span class="ot"><-</span><span class="fu">n_distinct</span>(emtala_pregnant<span class="sc">$</span>EVENT_ID)</span>
<span id="cb11-3"><a href="#cb11-3" tabindex="-1"></a></span>
<span id="cb11-4"><a href="#cb11-4" tabindex="-1"></a><span class="co">#number of EMTALA investigations overall since 2011</span></span>
<span id="cb11-5"><a href="#cb11-5" tabindex="-1"></a>count_invest<span class="ot"><-</span><span class="fu">n_distinct</span>(emtala_all<span class="sc">$</span>EVENT_ID)</span>
<span id="cb11-6"><a href="#cb11-6" tabindex="-1"></a></span>
<span id="cb11-7"><a href="#cb11-7" tabindex="-1"></a><span class="co">#percent of EMTALA investigations involving a pregnant patient since 2011 </span></span>
<span id="cb11-8"><a href="#cb11-8" tabindex="-1"></a><span class="fu">print</span>(<span class="fu">paste</span>(count_preg,<span class="st">"investigations of violations against pregnant patients, out of"</span>,count_invest,<span class="st">"investigations of overall. ("</span>,count_preg<span class="sc">/</span>count_invest<span class="sc">*</span><span class="dv">100</span>,<span class="st">"%)"</span>))</span></code></pre></div>
<pre><code>## [1] "417 investigations of violations against pregnant patients, out of 2694 investigations of overall. ( 15.4788418708241 %)"</code></pre>
<h2 id="emtala-violation-ranking">EMTALA violation ranking</h2>
<p>Web: “We found the most common EMTALA violation was “failure to
provide medical screening examinations.” (medical screening exam =
2406)</p>
<div class="sourceCode" id="cb13"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb13-1"><a href="#cb13-1" tabindex="-1"></a>emtala_pregnant <span class="sc">%>%</span></span>
<span id="cb13-2"><a href="#cb13-2" tabindex="-1"></a> <span class="fu">count</span>(deficiency_tag,<span class="at">sort=</span><span class="cn">TRUE</span>)</span></code></pre></div>
<pre><code>## # A tibble: 11 × 2
## deficiency_tag n
## <dbl> <int>
## 1 2406 262
## 2 2409 122
## 3 2405 87
## 4 2407 83
## 5 2400 77
## 6 2408 15
## 7 2411 12
## 8 2402 9
## 9 2404 9
## 10 2403 4
## 11 2401 3</code></pre>
<div class="sourceCode" id="cb15"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb15-1"><a href="#cb15-1" tabindex="-1"></a><span class="co"># filter emtala_pregnant for deficiency tag == 2406</span></span>
<span id="cb15-2"><a href="#cb15-2" tabindex="-1"></a>count_all_preg <span class="ot"><-</span> <span class="fu">n_distinct</span>(emtala_pregnant<span class="sc">$</span>key_identifier)</span>
<span id="cb15-3"><a href="#cb15-3" tabindex="-1"></a>count_2406 <span class="ot"><-</span> <span class="fu">n_distinct</span>((emtala_pregnant <span class="sc">%>%</span> <span class="fu">filter</span>(deficiency_tag <span class="sc">==</span> <span class="dv">2406</span>))<span class="sc">$</span>key_identifier)</span>
<span id="cb15-4"><a href="#cb15-4" tabindex="-1"></a></span>
<span id="cb15-5"><a href="#cb15-5" tabindex="-1"></a><span class="fu">print</span>(<span class="fu">paste</span>(count_2406,<span class="st">"medical screening violations against pregnant patients, out of"</span>,count_all_preg,<span class="st">"violations against pregnant patients of overall. ("</span>,count_2406<span class="sc">/</span>count_all_preg<span class="sc">*</span><span class="dv">100</span>,<span class="st">"%)"</span>))</span></code></pre></div>
<pre><code>## [1] "262 medical screening violations against pregnant patients, out of 683 violations against pregnant patients of overall. ( 38.3601756954612 %)"</code></pre>
<h2 id="turnaway-count">Turnaway count</h2>
<p>Rachel Gold and Karen Rodriguez also manually reviewed the EMTALA
violations for whether the pregnant patient was actually turned away by
the hospital.</p>
<p>Web: “Our investigation found of the cases that were investigated by
CMS, at least 241 involved pregnant women going to the ER for care and
being turned away.”</p>
<div class="sourceCode" id="cb17"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb17-1"><a href="#cb17-1" tabindex="-1"></a><span class="co"># I added "turnaway" as a column in confirmed_pregnant.xlsx</span></span>
<span id="cb17-2"><a href="#cb17-2" tabindex="-1"></a>turnaway <span class="ot"><-</span> emtala_pregnant <span class="sc">%>%</span> <span class="fu">filter</span>(turnaway <span class="sc">==</span> <span class="cn">TRUE</span>)</span>
<span id="cb17-3"><a href="#cb17-3" tabindex="-1"></a><span class="fu">n_distinct</span>(turnaway<span class="sc">$</span>EVENT_ID)</span></code></pre></div>
<pre><code>## [1] 241</code></pre>
<div class="sourceCode" id="cb19"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb19-1"><a href="#cb19-1" tabindex="-1"></a><span class="fu">n_distinct</span>(turnaway<span class="sc">$</span>facility_id)</span></code></pre></div>
<pre><code>## [1] 232</code></pre>
<h2 id="rural-vs-urban">Rural vs. urban</h2>
<p>Web: “EMTALA violations involving pregnancy […] included small
hospitals and large ones, in both rural and urban areas.”</p>
<div class="sourceCode" id="cb21"><pre class="sourceCode r"><code class="sourceCode r"><span id="cb21-1"><a href="#cb21-1" tabindex="-1"></a>emtala_facilities <span class="ot"><-</span> <span class="fu">read.csv</span>(<span class="st">"data/processed/3_etl_facility_summary.csv"</span>)</span>
<span id="cb21-2"><a href="#cb21-2" tabindex="-1"></a>emtala_facilities <span class="sc">%>%</span></span>
<span id="cb21-3"><a href="#cb21-3" tabindex="-1"></a> <span class="fu">count</span>(Rural.Status)</span></code></pre></div>
<pre><code>## Rural.Status n
## 1 No 165
## 2 Yes 129
## 3 <NA> 95</code></pre>
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