Ambulance diversions following public hospital emergency department closures
Objective To examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private. Data Sources/Study Setting Ambulance diversion logs for California hospitals, discharge...
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| Veröffentlicht in: | Health services research 2019-08, Vol.54 (4), p.870-879 |
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| creator | Hsuan, Charleen Hsia, Renee Y. Horwitz, Jill R. Ponce, Ninez A. Rice, Thomas Needleman, Jack |
| description | Objective
To examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private.
Data Sources/Study Setting
Ambulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007).
Study Design
We match public and private (nonprofit or for‐profit) hospitals by distance and size. We use random‐effects models examining diversion probability and timing of private hospitals following diversions by neighboring public vs matched private hospitals.
Data Collection/Extraction Methods
N/A.
Principal Findings
Hospitals are 3.6 percent more likely to declare diversions if neighboring diverting hospitals are public vs private (P |
| doi_str_mv | 10.1111/1475-6773.13147 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6606538</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A595705939</galeid><sourcerecordid>A595705939</sourcerecordid><originalsourceid>FETCH-LOGICAL-c7137-e08808c58b3e1d8413393a7176965d3fa18f85aba7fd15336e8f457f5530adfe3</originalsourceid><addsrcrecordid>eNqFkt1r2zAUxc3YWNNuz3sbhsHYYE6lyLLkl0EIXTsIFPbxLBT5ylGRrUyy2-W_r7xkWTzCZoEt5N89Pr73JMkrjKY4Xpc4ZzQrGCNTTOL-STI5nDxNJghhlpV4lp8l5yHcIYQ44fnz5IygMseMkkmynDer3spWQVqZe_DBuDak2lnrHkxbp5t-ZY1K1y5sTCdtCg34Glq1TSvYSN810Hapsi70HsKL5JmWNsDL_fMi-f7p6tviJlveXn9ezJeZYpiwDBDniCvKVwRwxXNMSEkkw6woC1oRLTHXnMqVZLrClJACuM4p05QSJCsN5CL5uNON7hqoVPTgpRUbbxrpt8JJI8ZvWrMWtbsXRYEKSngUeLcX8O5HD6ETjQkKbGwEuD6I2QzNCk4KnEf0zV_onet9G38vUhSxMs9Z-YeqpQVhWu3id9UgKua0pAzRkgxUdoKK7YRo0rWgTTwe8dMTfFwVNEadLHg_KohMBz-7WvYhCH69_JeZPavi6KEGEQe2uB3zb4_4NUjbrYOzfTckZgx-OAJXfTAthHgLpl53YedlhF_ucOVdCB70YY4YiSHkYoi0GCItfoU8Vrw-Hv-B_53qCBQ74CH2Z_s_PXFz9fXLTvkRDcoCxw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2250794479</pqid></control><display><type>article</type><title>Ambulance diversions following public hospital emergency department closures</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Hsuan, Charleen ; Hsia, Renee Y. ; Horwitz, Jill R. ; Ponce, Ninez A. ; Rice, Thomas ; Needleman, Jack</creator><creatorcontrib>Hsuan, Charleen ; Hsia, Renee Y. ; Horwitz, Jill R. ; Ponce, Ninez A. ; Rice, Thomas ; Needleman, Jack</creatorcontrib><description>Objective
To examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private.
Data Sources/Study Setting
Ambulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007).
Study Design
We match public and private (nonprofit or for‐profit) hospitals by distance and size. We use random‐effects models examining diversion probability and timing of private hospitals following diversions by neighboring public vs matched private hospitals.
Data Collection/Extraction Methods
N/A.
Principal Findings
Hospitals are 3.6 percent more likely to declare diversions if neighboring diverting hospitals are public vs private (P < 0.001). Hospitals declaring diversions have lower ED occupancy (P < 0.001) after neighboring public (vs private) hospitals divert. Hospitals have 4.2 percent shorter diversions if neighboring diverting hospitals are public vs private (P < 0.001). When the neighboring hospital ends its diversion first, hospitals terminate diversions 4.2 percent sooner if the neighboring hospital is public vs private (P = 0.022).
Conclusions
Sample hospitals respond differently to diversions by neighboring public (vs private) hospitals, suggesting that these hospitals might be strategically declaring ambulance diversions to avoid treating low‐paying patients served by public hospitals.</description><identifier>ISSN: 0017-9124</identifier><identifier>EISSN: 1475-6773</identifier><identifier>DOI: 10.1111/1475-6773.13147</identifier><identifier>PMID: 30941753</identifier><language>eng</language><publisher>United States: Health Research and Educational Trust</publisher><subject><![CDATA[access to care ; ambulance diversion ; Ambulance Diversion - statistics & numerical data ; Ambulances ; Analysis ; Bed Occupancy - statistics & numerical data ; Bypasses ; California ; Closures ; Data collection ; Discharge ; emergency department ; Emergency medical care ; Emergency medical services ; Emergency service ; Emergency Service, Hospital - statistics & numerical data ; Emergency services ; Emergency vehicles ; Extraction ; Health planning ; Health Policy and Organizational Behavior ; Hospital Bed Capacity - statistics & numerical data ; Hospital emergency services ; Hospitals ; Hospitals, Private - statistics & numerical data ; Hospitals, Public - statistics & numerical data ; Humans ; Occupancy ; Private hospitals ; Probability ; Public hospitals ; Residence Characteristics ; Socioeconomic Factors ; Time Factors]]></subject><ispartof>Health services research, 2019-08, Vol.54 (4), p.870-879</ispartof><rights>Health Research and Educational Trust</rights><rights>Health Research and Educational Trust.</rights><rights>COPYRIGHT 2019 Health Research and Educational Trust</rights><rights>COPYRIGHT 2019 Health Research and Educational Trust</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c7137-e08808c58b3e1d8413393a7176965d3fa18f85aba7fd15336e8f457f5530adfe3</citedby><cites>FETCH-LOGICAL-c7137-e08808c58b3e1d8413393a7176965d3fa18f85aba7fd15336e8f457f5530adfe3</cites><orcidid>0000-0001-5151-6718 ; 0000-0002-2875-0589 ; 0000-0001-9819-6926 ; 0000-0001-8720-2323</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606538/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606538/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,724,777,781,882,1412,27905,27906,30980,45555,45556,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30941753$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hsuan, Charleen</creatorcontrib><creatorcontrib>Hsia, Renee Y.</creatorcontrib><creatorcontrib>Horwitz, Jill R.</creatorcontrib><creatorcontrib>Ponce, Ninez A.</creatorcontrib><creatorcontrib>Rice, Thomas</creatorcontrib><creatorcontrib>Needleman, Jack</creatorcontrib><title>Ambulance diversions following public hospital emergency department closures</title><title>Health services research</title><addtitle>Health Serv Res</addtitle><description>Objective
To examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private.
Data Sources/Study Setting
Ambulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007).
Study Design
We match public and private (nonprofit or for‐profit) hospitals by distance and size. We use random‐effects models examining diversion probability and timing of private hospitals following diversions by neighboring public vs matched private hospitals.
Data Collection/Extraction Methods
N/A.
Principal Findings
Hospitals are 3.6 percent more likely to declare diversions if neighboring diverting hospitals are public vs private (P < 0.001). Hospitals declaring diversions have lower ED occupancy (P < 0.001) after neighboring public (vs private) hospitals divert. Hospitals have 4.2 percent shorter diversions if neighboring diverting hospitals are public vs private (P < 0.001). When the neighboring hospital ends its diversion first, hospitals terminate diversions 4.2 percent sooner if the neighboring hospital is public vs private (P = 0.022).
Conclusions
Sample hospitals respond differently to diversions by neighboring public (vs private) hospitals, suggesting that these hospitals might be strategically declaring ambulance diversions to avoid treating low‐paying patients served by public hospitals.</description><subject>access to care</subject><subject>ambulance diversion</subject><subject>Ambulance Diversion - statistics & numerical data</subject><subject>Ambulances</subject><subject>Analysis</subject><subject>Bed Occupancy - statistics & numerical data</subject><subject>Bypasses</subject><subject>California</subject><subject>Closures</subject><subject>Data collection</subject><subject>Discharge</subject><subject>emergency department</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency service</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Emergency services</subject><subject>Emergency vehicles</subject><subject>Extraction</subject><subject>Health planning</subject><subject>Health Policy and Organizational Behavior</subject><subject>Hospital Bed Capacity - statistics & numerical data</subject><subject>Hospital emergency services</subject><subject>Hospitals</subject><subject>Hospitals, Private - statistics & numerical data</subject><subject>Hospitals, Public - statistics & numerical data</subject><subject>Humans</subject><subject>Occupancy</subject><subject>Private hospitals</subject><subject>Probability</subject><subject>Public hospitals</subject><subject>Residence Characteristics</subject><subject>Socioeconomic Factors</subject><subject>Time Factors</subject><issn>0017-9124</issn><issn>1475-6773</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>N95</sourceid><sourceid>7QJ</sourceid><recordid>eNqFkt1r2zAUxc3YWNNuz3sbhsHYYE6lyLLkl0EIXTsIFPbxLBT5ylGRrUyy2-W_r7xkWTzCZoEt5N89Pr73JMkrjKY4Xpc4ZzQrGCNTTOL-STI5nDxNJghhlpV4lp8l5yHcIYQ44fnz5IygMseMkkmynDer3spWQVqZe_DBuDak2lnrHkxbp5t-ZY1K1y5sTCdtCg34Glq1TSvYSN810Hapsi70HsKL5JmWNsDL_fMi-f7p6tviJlveXn9ezJeZYpiwDBDniCvKVwRwxXNMSEkkw6woC1oRLTHXnMqVZLrClJACuM4p05QSJCsN5CL5uNON7hqoVPTgpRUbbxrpt8JJI8ZvWrMWtbsXRYEKSngUeLcX8O5HD6ETjQkKbGwEuD6I2QzNCk4KnEf0zV_onet9G38vUhSxMs9Z-YeqpQVhWu3id9UgKua0pAzRkgxUdoKK7YRo0rWgTTwe8dMTfFwVNEadLHg_KohMBz-7WvYhCH69_JeZPavi6KEGEQe2uB3zb4_4NUjbrYOzfTckZgx-OAJXfTAthHgLpl53YedlhF_ucOVdCB70YY4YiSHkYoi0GCItfoU8Vrw-Hv-B_53qCBQ74CH2Z_s_PXFz9fXLTvkRDcoCxw</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Hsuan, Charleen</creator><creator>Hsia, Renee Y.</creator><creator>Horwitz, Jill R.</creator><creator>Ponce, Ninez A.</creator><creator>Rice, Thomas</creator><creator>Needleman, Jack</creator><general>Health Research and Educational Trust</general><general>Blackwell Publishing Ltd</general><general>John Wiley and Sons Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>N95</scope><scope>XI7</scope><scope>8GL</scope><scope>7QJ</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5151-6718</orcidid><orcidid>https://orcid.org/0000-0002-2875-0589</orcidid><orcidid>https://orcid.org/0000-0001-9819-6926</orcidid><orcidid>https://orcid.org/0000-0001-8720-2323</orcidid></search><sort><creationdate>201908</creationdate><title>Ambulance diversions following public hospital emergency department closures</title><author>Hsuan, Charleen ; Hsia, Renee Y. ; Horwitz, Jill R. ; Ponce, Ninez A. ; Rice, Thomas ; Needleman, Jack</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c7137-e08808c58b3e1d8413393a7176965d3fa18f85aba7fd15336e8f457f5530adfe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>access to care</topic><topic>ambulance diversion</topic><topic>Ambulance Diversion - statistics & numerical data</topic><topic>Ambulances</topic><topic>Analysis</topic><topic>Bed Occupancy - statistics & numerical data</topic><topic>Bypasses</topic><topic>California</topic><topic>Closures</topic><topic>Data collection</topic><topic>Discharge</topic><topic>emergency department</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency service</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Emergency services</topic><topic>Emergency vehicles</topic><topic>Extraction</topic><topic>Health planning</topic><topic>Health Policy and Organizational Behavior</topic><topic>Hospital Bed Capacity - statistics & numerical data</topic><topic>Hospital emergency services</topic><topic>Hospitals</topic><topic>Hospitals, Private - statistics & numerical data</topic><topic>Hospitals, Public - statistics & numerical data</topic><topic>Humans</topic><topic>Occupancy</topic><topic>Private hospitals</topic><topic>Probability</topic><topic>Public hospitals</topic><topic>Residence Characteristics</topic><topic>Socioeconomic Factors</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hsuan, Charleen</creatorcontrib><creatorcontrib>Hsia, Renee Y.</creatorcontrib><creatorcontrib>Horwitz, Jill R.</creatorcontrib><creatorcontrib>Ponce, Ninez A.</creatorcontrib><creatorcontrib>Rice, Thomas</creatorcontrib><creatorcontrib>Needleman, Jack</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale Business: Insights</collection><collection>Business Insights: Essentials</collection><collection>Gale In Context: High School</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Health services research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hsuan, Charleen</au><au>Hsia, Renee Y.</au><au>Horwitz, Jill R.</au><au>Ponce, Ninez A.</au><au>Rice, Thomas</au><au>Needleman, Jack</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ambulance diversions following public hospital emergency department closures</atitle><jtitle>Health services research</jtitle><addtitle>Health Serv Res</addtitle><date>2019-08</date><risdate>2019</risdate><volume>54</volume><issue>4</issue><spage>870</spage><epage>879</epage><pages>870-879</pages><issn>0017-9124</issn><eissn>1475-6773</eissn><abstract>Objective
To examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private.
Data Sources/Study Setting
Ambulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007).
Study Design
We match public and private (nonprofit or for‐profit) hospitals by distance and size. We use random‐effects models examining diversion probability and timing of private hospitals following diversions by neighboring public vs matched private hospitals.
Data Collection/Extraction Methods
N/A.
Principal Findings
Hospitals are 3.6 percent more likely to declare diversions if neighboring diverting hospitals are public vs private (P < 0.001). Hospitals declaring diversions have lower ED occupancy (P < 0.001) after neighboring public (vs private) hospitals divert. Hospitals have 4.2 percent shorter diversions if neighboring diverting hospitals are public vs private (P < 0.001). When the neighboring hospital ends its diversion first, hospitals terminate diversions 4.2 percent sooner if the neighboring hospital is public vs private (P = 0.022).
Conclusions
Sample hospitals respond differently to diversions by neighboring public (vs private) hospitals, suggesting that these hospitals might be strategically declaring ambulance diversions to avoid treating low‐paying patients served by public hospitals.</abstract><cop>United States</cop><pub>Health Research and Educational Trust</pub><pmid>30941753</pmid><doi>10.1111/1475-6773.13147</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5151-6718</orcidid><orcidid>https://orcid.org/0000-0002-2875-0589</orcidid><orcidid>https://orcid.org/0000-0001-9819-6926</orcidid><orcidid>https://orcid.org/0000-0001-8720-2323</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Health services research, 2019-08, Vol.54 (4), p.870-879 |
| issn | 0017-9124 1475-6773 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6606538 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Applied Social Sciences Index & Abstracts (ASSIA); PubMed Central; Alma/SFX Local Collection |
| subjects | access to care ambulance diversion Ambulance Diversion - statistics & numerical data Ambulances Analysis Bed Occupancy - statistics & numerical data Bypasses California Closures Data collection Discharge emergency department Emergency medical care Emergency medical services Emergency service Emergency Service, Hospital - statistics & numerical data Emergency services Emergency vehicles Extraction Health planning Health Policy and Organizational Behavior Hospital Bed Capacity - statistics & numerical data Hospital emergency services Hospitals Hospitals, Private - statistics & numerical data Hospitals, Public - statistics & numerical data Humans Occupancy Private hospitals Probability Public hospitals Residence Characteristics Socioeconomic Factors Time Factors |
| title | Ambulance diversions following public hospital emergency department closures |
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