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Nau LM, Laux G, Altiner A, Szecsenyi J, Leutgeb R. The Use of Medical Services for Low-Acuity Emergency Cases in Germany: Protocol for a Multicenter Observational Pilot Study. JMIR Res Protoc 2024; 13:e54002. [PMID: 38598281 PMCID: PMC11043931 DOI: 10.2196/54002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The increasing number of requests for help for acutely ill patients and their management is a major problem in the health systems of many countries, but especially in Germany. Rescue coordination centers and ambulances in Germany are increasingly overloaded. As a result, rides as a part of rescue operations have been increasing in length for years, yet a relevant proportion of these operations represent low-acuity calls (LACs). The basic objective of this pilot study is the quantitative analysis of the potential misuse of requests to the rescue control center. Indications for alternative treatment options and how to handle these treatment options in nonacute, non-life-threatening health conditions, such as minor injuries or minor infectious diseases, will be assessed. The identification of these LACs is vital in order to prevent health care resources in emergency medical care becoming inadequate. OBJECTIVE The overarching goal of this study is to determine the percentage of unnecessary rescue missions on site and subsequently to obtain an impression of the paramedics' assessment of alternative treatment options or alternative methods of rescue transportation. METHODS This will be an exploratory, noninterventional, cross-sectional study with a quantitative approach. The study is multicentric, with 21 ambulances in 12 different locations. The data for this study were collected via a questionnaire, newly developed for this study, for rescue personnel. Additionally, secondary data from the responsible control center will be linked and processed in an initial descriptive analysis. This descriptive analysis will form the basis for a subsequent variance analysis. RESULTS Data collection started as projected on September 18, 2023, and was ongoing until end of November 2023. We expect the documentation of several thousand rescue operations. We expect the following study results: (1) many unnecessary rescue operations, (2) immediate on-site assessment of correct care and treatment, and (3) patients' reasons for calling a rescue coordination center. CONCLUSIONS To our knowledge, this is the first observational study in which acute rescue operations are recorded on site. The focus of this study is on the trained paramedics' assessment of whether rescue operations are necessary or not. Additionally, alternative treatments, such as out-of-hours care service or primary care service, are shown for each individual case. The study also intends to cover the question of which factors are relevant and statistically significantly connected to the misuse of ambulances. TRIAL REGISTRATION German Register for Clinical Studies (Deutsches Register für Klinische Studien) DRKS00032510; https://drks.de/search/en/trial/DRKS00032510. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54002.
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Affiliation(s)
- Lara Maria Nau
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Rüdiger Leutgeb
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
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Cheung EH, Whitfield DA, Kipust A, Tadeo R, Gausche-Hill M. Advancing Emergency Medical Services' (EMS) Response Capability for Behavioral Health Emergencies: Los Angeles County's Performance Improvement Initiative. PREHOSP EMERG CARE 2024:1-11. [PMID: 38526711 DOI: 10.1080/10903127.2024.2333494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Behavioral health emergencies (BHEs) are a common patient encounter for emergency medical services (EMS) clinicians and other first responders, in particular law enforcement (LE) officers. It is critical for EMS clinicians to have management strategies for BHEs, yet relatively little information exists on best practices. In 2016, the Los Angeles County EMS Agency's Commission initiated a comprehensive evaluation of the 9-1-1 response for BHEs and developed a plan for improving the quality of care and safety for patients and first responders. METHODS A Behavioral Health Initiative Committee was assembled with broad representation from EMS, LE, health agencies, and the public. Committee objectives included: 1) produce a process map of the BHE response from the time of a 9-1-1 call to patient arrival at transport destination, 2) identify and describe the different agencies that respond, 3) describe the critical decision points in the EMS and LE field responses, 4) acquire data that quantitatively and/or qualitatively describe the services available, and 5) recommend interventions for system performance improvement. RESULTS The committee generated comprehensive process maps for the prehospital response to BHEs, articulated principles for evaluation, and described key observations of the current system including: 9-1-1 dispatch criteria are variable and often defaults to a LE response, the LE response inadvertently criminalizes BHEs, EMS field treatment protocols for BHEs (and especially agitated patients) are limited, substance use disorder treatment lacks integration, destination options differ by transporting agency, and receiving facilities' capabilities to address BHEs are variable. Recommendations for performance improvement interventions and initial implementation steps included: standardize dispatch protocols, shift away from a LE primary response, augment EMS treatment protocols for BHEs and the management of agitation, develop alternate destination for EMS transport. CONCLUSION This paper describes a comprehensive performance improvement initiative in LAC-EMSA's 9-1-1 response to BHEs. The initiative included a thorough current state analysis, followed by future state mapping and the implementation of interventions to reduce LE as the primary responder when an EMS response is often warranted, and to improve EMS protocols and access to resources for BHEs.
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Affiliation(s)
- Erick H Cheung
- David Geffen School of Medicine, Department of Psychiatry, University of California Los Angeles (UCLA), Los Angeles, California
- UCLA Resnick Neuropsychiatric Hospital, Los Angeles, California
| | - Denise A Whitfield
- Los Angeles County Emergency Medical Services Agency, Los Angeles, California
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California
- The Lundquist Institute, Los Angeles, California
| | | | - Richard Tadeo
- Los Angeles County Emergency Medical Services Agency, Los Angeles, California
| | - Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services Agency, Los Angeles, California
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California
- The Lundquist Institute, Los Angeles, California
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3
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Tan CD, Vermont CL, Zachariasse JM, von Both U, Eleftheriou I, Emonts M, van der Flier M, Herberg J, Kohlmaier B, Levin M, Lim E, Maconochie IK, Martinon-Torres F, Nijman RG, Pokorn M, Rivero-Calle I, Tsolia M, Zenz W, Zavadska D, Moll HA, Carrol ED. Emergency medical services utilisation among febrile children attending emergency departments across Europe: an observational multicentre study. Eur J Pediatr 2023; 182:3939-3947. [PMID: 37354239 PMCID: PMC10570223 DOI: 10.1007/s00431-023-05056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/24/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
Children constitute 6-10% of all patients attending the emergency department (ED) by emergency medical services (EMS). However, discordant EMS use in children occurs in 37-61% with fever as an important risk factor. We aimed to describe EMS utilisation among febrile children attending European EDs. This study is part of an observational multicentre study assessing management and outcome in febrile children up to 18 years (MOFICHE) attending twelve EDs in eight European countries. Discordant EMS use was defined as the absence of markers of urgency including intermediate/high triage urgency, advanced diagnostics, treatment, and admission in children transferred by EMS. Multivariable logistic regression analyses were performed for the association between (1) EMS use and markers of urgency, and (2) patient characteristics and discordant EMS use after adjusting all analyses for the covariates age, gender, visiting hours, presenting symptoms, and ED setting. A total of 5464 (15%, range 0.1-42%) children attended the ED by EMS. Markers of urgency were more frequently present in the EMS group compared with the non-EMS group. Discordant EMS use occurred in 1601 children (29%, range 1-59%). Age and gender were not associated with discordant EMS use, whereas neurological symptoms were associated with less discordant EMS use (aOR 0.2, 95%CI 0.1-0.2), and attendance out of office hours was associated with more discordant EMS use (aOR 1.6, 95%CI 1.4-1.9). Settings with higher percentage of self-referrals to the ED had more discordant EMS use (p < 0.05). Conclusion: There is large practice variation in EMS use in febrile children attending European EDs. Markers of urgency were more frequently present in children in the EMS group. However, discordant EMS use occurred in 29%. Further research is needed on non-medical factors influencing discordant EMS use in febrile children across Europe, so that pre-emptive strategies can be implemented. What is Known: •Children constitute around 6-10% of all patients attending the emergency department by emergency medical services. •Discordant EMS use occurs in 37-61% of all children, with fever as most common presenting symptom for discordant EMS use in children. What is New: •There is large practice variation in EMS use among febrile children across Europe with discordance EMS use occurring in 29% (range 1-59%), which was associated with attendance during out of office hours and with settings with higher percentage of self-referrals to the ED. •Future research is needed focusing on non-medical factors (socioeconomic status, parental preferences and past experience, healthcare systems, referral pathways, out of hours services provision) that influence discordant EMS use in febrile children across Europe.
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Affiliation(s)
- Chantal D. Tan
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Clementien L. Vermont
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Joany M. Zachariasse
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilians University, Munich, Germany
- German Centre for Infection Research, DZIF, Partner Site, Munich, Germany
| | - Irini Eleftheriou
- Second Department of Paediatrics, P. and A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Trust, Westgate Rd, Newcastle Upon Tyne, NE4 5PL UK
| | - Michiel van der Flier
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, RadboudUMC, Nijmegen, the Netherlands
- Paediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, RadboudUMC, Nijmegen, the Netherlands
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jethro Herberg
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Michael Levin
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Emma Lim
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Department of Medicine, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ian K. Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, London, UK
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ruud G. Nijman
- Section of Paediatric Infectious Diseases, Imperial College, London, UK
| | - Marko Pokorn
- Department of Infectious Diseases and Faculty of Medicine, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Irene Rivero-Calle
- Genetics, Vaccines, Infections and Paediatrics Research Group (GENVIP), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria Tsolia
- Second Department of Paediatrics, P. and A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Dace Zavadska
- Department of Paediatrics, Children Clinical University Hospital, Rīgas Stradiņa Universitāte, Riga, Latvia
| | - Henriëtte A. Moll
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Enitan D. Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
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Zottarelli LK, Xu X, Sunil TS, Chowdhury S. Just Plain Hot: Examining Summer Daily High Heat Indices and Community-Level Social Vulnerability on Emergency Medical Services On-Scene Responses in San Antonio, Texas, 2015-2018. Cureus 2023; 15:e39914. [PMID: 37404445 PMCID: PMC10317480 DOI: 10.7759/cureus.39914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Increased summer heat has a deleterious effect on people's health and the healthcare system. Emergency Medical Services (EMS) are at the healthcare system frontline, responsive to the community and environmental conditions. The present study examined how EMS on-scene response is affected by community-level social vulnerability and heat. Methods The Centers for Disease Control and Prevention's Social Vulnerability Index, heat and humidity data from the National Weather Service, and City of San Antonio EMS data were collected. Data were analyzed using negative binomial regression models with time-stratified case-crossover design to observe independent and interactive effects of heat and social vulnerability on EMS on-scene response over four constricted calendar years. Results Results indicated that community-based social vulnerability and heat, independently and interactively, are associated with increased EMS on-scene responses. Conclusion Even when examining normal summertime heat conditions, there is evidence of the relationships between geographic and environmental conditions and the healthcare system.
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Affiliation(s)
| | - Xiaohe Xu
- Sociology, University of Texas at San Antonio, San Antonio, USA
| | - Thankam S Sunil
- Public Health, University of Tennessee, Knoxville, Knoxville, USA
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Turbow SD, Culler SD, Vaughan CP, Rask KJ, Perkins MM, Clevenger CK, Ali MK. Ambulance use and subsequent fragmented hospital readmission among older adults. J Am Geriatr Soc 2023; 71:1416-1428. [PMID: 36573624 PMCID: PMC10175179 DOI: 10.1111/jgs.18210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Interhospital care fragmentation, when a patient is readmitted to a different hospital than they were originally discharged from, occurs in 20%-25% of readmissions. Mode of transport to the hospital, specifically ambulance use, may be a risk factor for fragmented readmissions. Our study seeks to further understand the relationship between ambulance transport and fragmented readmissions in older adults, a population that is at increased risk for poor outcomes following fragmented readmissions. METHODS We analyzed inpatient claims from Medicare beneficiaries in 2018 who had a hospital admission for select Hospital Readmission Reduction Program Conditions (acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia) as well as dehydration, syncope, urinary tract infection, or behavioral issues. We evaluated the associations between ambulance transport and a fragmented readmission using logistic regression models adjusted for demographic, clinical, and hospital characteristics. RESULTS The study included 1,186,600 30-day readmissions. Of these, 46.8% (n = 555,847) required ambulance transport. In fully adjusted models, taking an ambulance to the readmission hospital increased the odds of a fragmented readmission by 38% (95% CI 1.32, 1.44). When this association was examined by readmission major diagnostic category (MDC), the strongest associations were seen for Factors Influencing Health Status and Other Contacts with Health Services (i.e., rehabilitation, aftercare) (AOR 3.66, 95% CI 3.11, 4.32), Mental Diseases and Disorders (AOR 2.69, 95% CI 2.44, 2.97), and Multiple Significant Trauma (AOR 2.61, 95% CI 1.56, 4.35). When the model was stratified by patient origin, ambulance use remained associated with fragmented readmissions across all locations. CONCLUSIONS Ambulance use is associated with increased odds of a fragmented readmission, though the strength of the association varies by readmission diagnosis and origin. Patient-, hospital-, and system-level interventions should be developed, implemented, and evaluated to address this modifiable risk factor.
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Affiliation(s)
- Sara D Turbow
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Family & Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Steven D Culler
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Camille P Vaughan
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, Georgia, USA
| | | | - Molly M Perkins
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carolyn K Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Mohammed K Ali
- Department of Family & Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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6
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Turbow SD, Uppal T, Chang HH, Ali MK. Association of distance between hospitals and volume of shared admissions. BMC Health Serv Res 2022; 22:1528. [DOI: 10.1186/s12913-022-08931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/05/2022] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
To assess whether decreasing distance between hospitals was associated with the number of shared patients (patients with an admission to one hospital and a readmission to another).
Methods
Data were from the Healthcare Cost and Utilization Project’s State Inpatient Databases (Florida, Georgia, Maryland, Utah [2017], New York, Vermont [2016]) and the American Hospital Association Annual Survey (2016 & 2017). This was a cross-sectional analysis of patients who had an index admission and subsequent readmission at different hospitals within the same year. We used unadjusted and adjusted linear regression to evaluate the association between the number of shared patients and the distance between admission-readmission hospital pairs.
Results
There were 691 hospitals in the sample (247 in Florida, 151 in Georgia, 50 in Maryland, 172 in New York, 58 in Utah, and 13 in Vermont), accounting for a total of 596,772 admission-readmission pairs. 32.6% of the admission-readmission pairs were shared between two hospitals. On average, a one-mile decrease in distance between two hospitals was associated with of 3.05 (95% CI, 3.02, 3.07) more shared admissions. However, variability between states was wide, with Utah having 0.37 (95% CI 0.35, 0.39) more shared admissions between hospitals per one-mile shorter distance, and Maryland having 4.98 (95% CI 4.87, 5.08) more.
Conclusions
We found that proximity between hospitals is associated with higher volumes of shared admissions.
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Paulin J, Kurola J, Koivisto M, Iirola T. EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety? BMC Emerg Med 2021; 21:115. [PMID: 34627138 PMCID: PMC8502399 DOI: 10.1186/s12873-021-00508-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/27/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The safety of the Emergency Medical Service's (EMS's) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality. METHODS This cohort study used prospectively collected data on non-conveyed EMS patients from three different regions in Finland between June 1 and November 30, 2018. The Adjusted International Classification of Primary Care (ICPC2) as the reason for care was compared to hospital discharge diagnoses (ICD10). Multivariable logistic regressions were used to determine factors that were independently associated with adverse outcomes. Results are presented with adjusted odds ratios (aORs) together with 95% confidence intervals (CIs). Data regarding deceased patients were reviewed by the study group. RESULTS Of the non-conveyed EMS patients (n = 11,861), 6.3% re-contacted the EMS, 8.3% attended a primary health care facility, 4.2% went to the ED, 1.6% were hospitalized, and 0.1% died 0-24 h after the EMS mission. The 0-24 h adverse event rate was higher than 24-48 h. After non-conveyance, 32 (0.3%) patients were admitted to an intensive care unit within 24 h. Primary non-urgent EMS mission (aOR 1.49; 95% CI 1.25 to 1.77), EMS arrival at night (aOR 1.82; 95% CI 1.58 to 2.09), ALS unit type vs BLS (aOR 1.43; 95% CI 1.16 to 1.77), rural area (aOR 1.74; 95% CI 1.51 to 1.99), and older patient age (aOR 1.41; 95% CI 1.20 to 1.66) were associated with subsequent primary health care visits (0-24 h). CONCLUSIONS Four in five non-conveyed patients did not have any re-contact in follow-up period. EMS non-conveyance seems to be a relatively safe method of focusing ED resources and avoiding ED crowding.
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Affiliation(s)
- Jani Paulin
- Department of Clinical Medicine, University of Turku and Turku University of Applied Sciences, Turku, Finland.
| | - Jouni Kurola
- Centre for Prehospital Emergency Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Timo Iirola
- Emergency Medical Services, Turku University Hospital and University of Turku, Turku, Finland
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Pedrotti CHS, Accorsi TAD, Amicis Lima KD, Filho JRDOS, Morbeck RA, Cordioli E. Cross-sectional study of the ambulance transport between healthcare facilities with medical support via telemedicine: Easy, effective, and safe tool. PLoS One 2021; 16:e0257801. [PMID: 34591876 PMCID: PMC8483335 DOI: 10.1371/journal.pone.0257801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 09/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Feasibility and safety of ambulance transport between healthcare facilities with medical support exclusively via telemedicine are unknown. Methods This was a retrospective study with a single telemedicine center reference for satellite emergency departments of the same hospital. The study population was all critically ill patients admitted to one of the peripheral units from November 2016 to May 2020 and who needed to be transferred to the main building. Telemedicine-assisted transportation was performed by an emergency specialist. The inclusion criteria included patients above the age of 15 and initial stabilization performed at the emergency department. Unstable, intubated, ST-elevation myocardial infarction and acute stroke patients were excluded. There was a double-check of safety conditions by the nurse and the remote doctor before the ambulance departure. The primary endpoint was the number of telemedicine-guided interventions during transport. Results 2840 patients were enrolled. The population was predominantly male (53.2%) with a median age of 60 years. Sepsis was the most prevalent diagnosis in 28% of patients, followed by acute coronary syndromes (8.5%), arrhythmia (6.7%), venous thromboembolism (6.1%), stroke (6.1%), acute abdomen (3.6%), respiratory distress (3.3%), and heart failure (2.5%). Only 22 (0.8%) patients required telemedicine-assisted support during transport. Administration of oxygen therapy and analgesics were the most common recommendations made by telemedicine emergency physicians. There were no communication problems in the telemedicine-assisted group. Conclusions Telemedicine-assisted ambulance transportation between healthcare facilities of stabilized critically ill patients may be an option instead of an onboard physician. The frequency of clinical support requests by telemedicine is minimal, and most evaluations are of low complexity and easily and safely performed by trained nurses.
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Affiliation(s)
- Carlos H. S. Pedrotti
- Telemedicine Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- * E-mail:
| | - Tarso A. D. Accorsi
- Telemedicine Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Renata A. Morbeck
- Telemedicine Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Eduardo Cordioli
- Telemedicine Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Melgoza E, Beltrán-Sánchez H, Bustamante AV. Emergency Medical Service Use Among Latinos Aged 50 and Older in California Counties, Except Los Angeles, During the Early COVID-19 Pandemic Period. Front Public Health 2021; 9:660289. [PMID: 34497790 PMCID: PMC8419352 DOI: 10.3389/fpubh.2021.660289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has disproportionately affected Latino adults aged 50 and older in California. Among adults aged 50-64, Latinos constitute approximately one-third (32%) of the population, but over half (52%) of COVID-19 cases, and more than two-thirds (64%) of COVID-related deaths as of June 2, 2021. These health disparities are also prevalent among Latinos 65 years and older who constitute 22% of the population, but 40% of confirmed COVID-19 cases and 50% of COVID-related deaths. Emergency medical services (EMS) are an essential component of the United States healthcare system and a vital sector in COVID-19 response efforts. Using data from the California Emergency Medical Services Information System (CEMSIS), this study examines racial and ethnic differences in respiratory distress related EMS calls among adults aged 50 and older in all counties except Los Angeles. This study compares the early pandemic period, January to June 2020, to the same time period in 2019. Between January and June 2019, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks, Asians, and Whites. During the early pandemic period, January to June 2020, Latinos aged 50 and older had statistically significantly lower odds of respiratory distress related EMS calls compared to Blacks but slightly higher odds compared to Whites. Differences by race/ethnicity and region were statistically significant. Understanding EMS health disparities is crucial to inform policies that create a more equitable prehospital care system for the heterogeneous population of middle aged and older adults.
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Affiliation(s)
- Esmeralda Melgoza
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- UCLA Latino Policy and Politics Initiative, Los Angeles, CA, United States
| | - Hiram Beltrán-Sánchez
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- UCLA Latino Policy and Politics Initiative, Los Angeles, CA, United States
- UCLA California Center for Population Research, Los Angeles, CA, United States
| | - Arturo Vargas Bustamante
- UCLA Latino Policy and Politics Initiative, Los Angeles, CA, United States
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States
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Biswas S, Dinh D, Lucas M, Duffy SJ, Brennan A, Liew D, Cox N, Smith K, Andrew E, Nehme Z, Reid CM, Lefkovits J, Stub D. Impact of limited English proficiency on presentation and clinical outcomes of patients undergoing primary percutaneous coronary intervention. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:254-262. [PMID: 31782766 DOI: 10.1093/ehjqcco/qcz061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/06/2019] [Accepted: 11/26/2019] [Indexed: 11/13/2022]
Abstract
AIMS To evaluate the association of limited English proficiency (LEP) with reperfusion times and outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS This cohort study included 5385 patients who underwent PPCI in 2013-2017 and were prospectively enrolled in the Victorian Cardiac Outcomes Registry. Data linkage to government administrative datasets was performed to identify patients' preferred spoken language, socioeconomic status, and ambulance utilization data. Patients who had a preferred spoken language other than English were defined as having LEP. Of the study cohort, 430 patients (8.0%) had LEP. They had longer mean symptom-to-door time (STDT) [164 (95% confidence interval, CI 149-181) vs. 136 (95% CI 132-140) min, P < 0.001] but similar mean door-to-balloon time [79 (95% CI 72-87) vs. 76 (95% CI 74-78) min, P = 0.41]. They also had higher major adverse cardiovascular and cerebrovascular events (MACCE; 13.5% vs. 9.9%; P = 0.02), severe left ventricular dysfunction (11.0% vs. 8.4%, P = 0.02), and heart failure (HF) hospitalizations within 30 days of PPCI (5.1% vs. 2.0%, P < 0.001). On multivariable analysis, LEP did not independently predict 30-day MACCE [odds ratio (OR) 1.16, 95% CI 0.79-1.69; P = 0.45] but was an independent predictor of both prolonged STDT ≥ 120 min (OR 1.25, 95% CI 1.02-1.52; P = 0.03) and 30-day HF hospitalizations (OR 2.01, 95% CI 1.21-3.36; P = 0.008). CONCLUSION Patients with LEP undergoing PPCI present later and are more likely to have HF readmissions within 30 days of percutaneous coronary intervention, but with similar short-term MACCE. More effort to provide education in varied languages on early presentation in STEMI is required.
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Affiliation(s)
- Sinjini Biswas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Lucas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephen J Duffy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia
| | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of General Medicine, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Gordon Street, Footscray, VIC 3011, Australia.,Department of Medicine, Melbourne Medical School-Western Precinct, The University of Melbourne, Furlong Road, St Albans, VIC 3021, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Manningham Road, Doncaster, VIC 3108, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, McMahons Road, Frankston, VIC 3199, Australia
| | - Emily Andrew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Manningham Road, Doncaster, VIC 3108, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Manningham Road, Doncaster, VIC 3108, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, McMahons Road, Frankston, VIC 3199, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,School of Public Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Grattan Street, Melbourne, VIC 3050, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia.,Department of Cardiology, Western Health, Gordon Street, Footscray, VIC 3011, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Manningham Road, Doncaster, VIC 3108, Australia.,Baker Heart and Diabetes Institute, Commercial Road, Melbourne, VIC 3004, Australia
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11
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Birmingham LE, Arens A, Longinaker N, Kummet C. Trends in ambulance transports and costs among Medicare beneficiaries, 2007-2018. Am J Emerg Med 2021; 47:205-212. [PMID: 33895702 DOI: 10.1016/j.ajem.2021.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The primary purpose of this study was to evaluate trends in ambulance utilization and costs among Medicare beneficiaries from 2007 to 2018. Community characteristics associated with ambulance use and costs are also explored. METHODS Aggregated county-level fee-for-service (FFS) Medicare beneficiary claims data from 2007 to 2018 were used to assess ambulance transports per 1000 FFS Medicare beneficiaries and standardized inflation-adjusted ambulance costs. Multivariable linear mixed models were used to quantify trends in ambulance utilization and costs and to control for confounders. RESULTS A total of 37,675 county-years were included from 2007 to 2018. Ambulance transports per 1000 beneficiaries increased 15% from 299 (95% CI: 291.63, 307.30) to 345 (95% CI: 336.91, 353.10) from 2007 to 2018. Inflation-adjusted standardized per user costs exhibited an increasing (1.04, 95% CI: 1.04, 1.05), but non-linear relationship (0.996, 95% CI: 0.996, 0.996) over time with costs peaking in 2012. Indicators of lower socioeconomic status (SES) were associated with increases in both ambulance events and costs (p < .0001). A higher prevalence of Medicare beneficiaries utilizing Skilled Nursing Facilities was associated with increased levels of ambulance events per 1000 beneficiaries (95% CI: 8.06, 10.63). Rural location was associated with a 38% increase in ambulance costs (95% CI 1.30-1.47) compared to urban location. CONCLUSIONS Numerous policy solutions have been proposed to address growing ambulance costs in the Medicare program. While ambulance transports and costs continue to increase, a bend in the ambulance cost curve is detected suggesting that one or more policies altered Medicare ambulance costs, although utilization has continued to grow linearly. Ambulance use and costs vary significantly with community-level factors. As policy makers consider how to address growing ambulance use and costs, targeting identified community-level factors associated with greater costs and utilization, and their root causes, may offer a targeted approach to addressing current trends.
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Affiliation(s)
- Lauren E Birmingham
- General Dynamics Information Technology (GDIT), Federal Civilian Division, West Des Moines, IA, United States of America.
| | - Andrea Arens
- General Dynamics Information Technology (GDIT), Federal Civilian Division, West Des Moines, IA, United States of America
| | - Nyaradzo Longinaker
- General Dynamics Information Technology (GDIT), Federal Civilian Division, West Des Moines, IA, United States of America
| | - Colleen Kummet
- General Dynamics Information Technology (GDIT), Federal Civilian Division, West Des Moines, IA, United States of America
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12
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Choice of Transport to Hospital in Nonurban Areas in Life-Threatening Situations: A Qualitative Research. J Ambul Care Manage 2021; 44:155-165. [PMID: 33591130 DOI: 10.1097/jac.0000000000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The time it takes to begin treatment in life-threatening situations is critical. Ambulance transport to the hospital in such situations ensures quick and effective treatment but is not always readily available in nonurban areas, or not preferred by the public, for various reasons. The purpose of this qualitative study was to examine the factors that deter or encourage ambulance use in life-threatening situations in the geographic periphery from clients' perspectives. We conducted interviews with 71 patients in 3 medical centers who had arrived by ambulance or by private transport, and with the 3 emergency department directors. The findings revealed that awareness of the clinical situation and health literacy, accessibility of emergency services, geographical conditions, and social and economic factors are central in the decision to utilize this service. We detail research recommendations for strengthening public health literacy and access to services.
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13
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Vogel JA, Burnham RI, McVaney K, Havranek EP, Edwards D, Hulac S, Sasson C. The Importance of Neighborhood in 9-1-1 Ambulance Contacts: A Geospatial Analysis of Medical and Trauma Emergencies in Denver. PREHOSP EMERG CARE 2021; 26:233-245. [DOI: 10.1080/10903127.2020.1868634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Asaithambi G, Tong X, Lakshminarayan K, Coleman King SM, George MG, Odom EC. Emergency Medical Services Utilization for Acute Stroke Care: Analysis of the Paul Coverdell National Acute Stroke Program, 2014-2019. PREHOSP EMERG CARE 2021; 26:326-332. [PMID: 33464940 DOI: 10.1080/10903127.2021.1877856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Emergency medical service (EMS) transportation after acute stroke is associated with shorter symptom-to-arrival times and more rapid medical attention when compared to patient transportation by private vehicle. Methods: We analyzed data from the Paul Coverdell National Acute Stroke Program from 2014 to 2019 among stroke (ischemic and hemorrhagic) and transient ischemic attack (TIA) patients to examine patterns in EMS utilization. Results: Of 500,829 stroke and TIA patients (mean age 70.9 years, 51.3% women) from 682 participating hospitals during the study period, 60% arrived by EMS. Patients aged 18-64 years vs. ≥65 years (AOR 0.67) were less likely to utilize EMS. Severe stroke patients (AOR 2.29, 95%CI, 2.15-2.44) and hemorrhagic stroke patients vs. ischemic stroke patients (AOR 1.47, 95% CI, 1.43-1.51) were more likely to utilize EMS. Medicare (AOR 1.35, 95% CI, 1.32-1.38) and Medicaid (AOR 1.41, 95% CI, 1.37-1.45) beneficiaries were more likely than privately insured patients to utilize EMS, but no difference was found between no insurance/self-pay patients and privately insured patients on EMS utilization. Overall, there was a decreasing trend in the utilization of EMS (59.6% to 59.3%, p = 0.037). The decreasing trend was identified among ischemic stroke (p < 0.0001) patients but not among TIA (p = 0.89) or hemorrhagic stroke (p = 0.44) patients. There was no observed trend in pre-notification among stroke patients' arrival by EMS across the study period (56.9% to 56.5%, p = 0.99). Conclusions: Strategies to help increase stroke awareness and utilization of EMS among those with symptoms of stroke should be considered in order to help improve stroke outcomes.
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Affiliation(s)
- Ganesh Asaithambi
- Received November 15, 2020 from United Hospital Department of Neurosciences, Allina Health, St. Paul, Minnesota, USA (GA); Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (XT, SMCK, MGG; ECO); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA (KL); Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA (KL). Revision received January 14, 2021; accepted for publication January 14, 2021
| | - Xin Tong
- Received November 15, 2020 from United Hospital Department of Neurosciences, Allina Health, St. Paul, Minnesota, USA (GA); Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (XT, SMCK, MGG; ECO); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA (KL); Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA (KL). Revision received January 14, 2021; accepted for publication January 14, 2021
| | - Kamakshi Lakshminarayan
- Received November 15, 2020 from United Hospital Department of Neurosciences, Allina Health, St. Paul, Minnesota, USA (GA); Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (XT, SMCK, MGG; ECO); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA (KL); Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA (KL). Revision received January 14, 2021; accepted for publication January 14, 2021
| | - Sallyann M Coleman King
- Received November 15, 2020 from United Hospital Department of Neurosciences, Allina Health, St. Paul, Minnesota, USA (GA); Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (XT, SMCK, MGG; ECO); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA (KL); Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA (KL). Revision received January 14, 2021; accepted for publication January 14, 2021
| | - Mary G George
- Received November 15, 2020 from United Hospital Department of Neurosciences, Allina Health, St. Paul, Minnesota, USA (GA); Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (XT, SMCK, MGG; ECO); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA (KL); Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA (KL). Revision received January 14, 2021; accepted for publication January 14, 2021
| | - Erika C Odom
- Received November 15, 2020 from United Hospital Department of Neurosciences, Allina Health, St. Paul, Minnesota, USA (GA); Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (XT, SMCK, MGG; ECO); Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA (KL); Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA (KL). Revision received January 14, 2021; accepted for publication January 14, 2021
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15
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Investigating the Geographic Disparities of Amenable Mortality and Related Ambulance Services in Hungary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031065. [PMID: 33504113 PMCID: PMC7908127 DOI: 10.3390/ijerph18031065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate how amenable mortality and related ambulance services differ on a county level in Hungary. The differences in mortality rates and ambulance services could identify counties where stronger ambulance services are needed. The datasets for 2018 consisted of county level aggregated data of citizens between the ages 15–64. The study examined how both the mortality rates and the ambulance rescue deliveries differ from the national average. The analyses were narrowed down to disease groups, such as acute myocardial infarction, hemorrhagic and ischemic stroke. Inequalities were identified regarding the distribution of number of ambulance deliveries, several counties had rates more than double that of the national average. For both mortality and ambulance services some of the counties had significantly better results and others had significantly worse compared to the national average. In Borsod-Abaúj-Zemplén county’s case, hemorrhagic stroke mortality was significantly higher (1.73 [1.35–2.11]), while ambulance deliveries were significantly lower (0.58 [0.40–0.76]) compared to the national average. The research has shown that regarding the investigated mortality rates and ambulance services there are considerable differences between the counties in Hungary. In this regard policy makers should implement policies to tackle these discrepancies.
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16
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Winchester DE, Osborne A, Peacock WF, Bhatt DL, Dehmer GJ, Diercks D, Masoudi FA, McCord J, Kontos M, Levy PD. Closing Gaps in Essential Chest Pain Care Through Accreditation. J Am Coll Cardiol 2020; 75:2478-2482. [PMID: 32408982 DOI: 10.1016/j.jacc.2020.03.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- David E Winchester
- Malcom Randall Veterans Affairs Medical Center, University of Florida College of Medicine, Gainesville, Florida.
| | - Anwar Osborne
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - W Frank Peacock
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Gregory J Dehmer
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Deborah Diercks
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - James McCord
- Heart and Vascular Institute and Department of Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Michael Kontos
- Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Phillip D Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, Michigan
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17
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Moafa HN, van Kuijk SMJ, Alqahtani DM, Moukhyer ME, Haak HR. Disparities between Rural and Urban Areas of the Central Region of Saudi Arabia in the Utilization and Time-Centeredness of Emergency Medical Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217944. [PMID: 33138091 PMCID: PMC7663470 DOI: 10.3390/ijerph17217944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time (RT). The study retrospectively evaluated 146,639 completed missions in 2018 by measuring the utilization rate in rural and urban areas. The study shows there are six times more ambulance crews available for rural areas compared to urban. There were 22.1 missions per 1000 urban inhabitants and 11.2 missions per 1000 in rural areas. The median RT for high urgent trauma cases was 20.2 min in rural compared to 15.2 min in urban areas (p < 0.001). In urban areas, the median RT for high urgent medical cases was 16.1 min, while it was 15.2 min for high urgent trauma cases. Around 62.3% of emergency cases in urban and 56.5% in rural areas were responded to within 20.00 min. Women utilized EMS less frequently. The RT was increased in urban areas compared to previous studies. The RT in the central region of SA has been identified as equal, or less than 20.00 min in 62.4% of all emergency cases. To further improve adherence to the 20' target, reorganizing the lowest urgent cases in the rural areas seems necessary.
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Affiliation(s)
- Hassan N. Moafa
- Department of Health Services Management, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan 82817 2820, Saudi Arabia
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
- Correspondence: or ; Tel.: +31-615-373-733
| | - Sander Martijn Job van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
| | - Dhafer M. Alqahtani
- Department of Quality Management, Saudi Red Crescent Authority, Ministry of Health, Riyadh 13251-8261, Saudi Arabia;
| | - Mohammed E. Moukhyer
- Department of Academic Development and Quality, Faculty of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia;
| | - Harm R. Haak
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Internal Medicine, Maxima Medisch Centre, 5631 BM Eindhoven, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
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18
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Pollack CE, Du S, Blackford AL, Herring B. Experiment To Decrease Neighborhood Poverty Had Limited Effects On Emergency Department Use. Health Aff (Millwood) 2020; 38:1442-1450. [PMID: 31479355 DOI: 10.1377/hlthaff.2019.00452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neighborhood environments are increasingly thought to affect emergency department (ED) use. However, because people decide where to live based on a range of factors, it can be challenging to identify the causal impact of living in higher-poverty neighborhoods on increased rates of ED visits. Our study leveraged the Moving to Opportunity for Fair Housing Demonstration Program, a social experiment beginning in 1994 that randomly assigned approximately 4,600 households that received federal housing assistance to different neighborhood conditions. We linked program participants in four states with an average of twelve years of administrative data on ED use (up to twenty-one years after randomization). Contrary to our expectations, we did not find a consistently significant connection between neighborhood poverty and overall ED use during this follow-up period. This result was observed for both adults and people who were children at the time of randomization, as well as for various classifications of ED visits. The findings can help direct future research that seeks to clarify the relationship between neighborhood environments and health care use.
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Affiliation(s)
- Craig E Pollack
- Craig E. Pollack ( ) is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Shawn Du
- Shawn Du was formerly a PhD student in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health. He is now an associate at Analysis Group in New York City
| | - Amanda L Blackford
- Amanda L. Blackford is a principal biostatistician in the Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins School of Medicine, in Baltimore
| | - Bradley Herring
- Bradley Herring is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
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Disparities in Emergency Department Visits Among Collocated Racial/Ethnic Medicare Enrollees. Ann Emerg Med 2019; 73:225-235. [PMID: 30798793 DOI: 10.1016/j.annemergmed.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/28/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE We estimate emergency department (ED) use differences across Medicare enrollees of different race/ethnicity who are residing in the same zip codes. METHODS In this retrospective cohort study, we stratified all Medicare fee-for-service beneficiaries aged 66 years and older (2006 to 2012) by residence zip code and identified zip codes with racial/ethnic diversity, defined as containing at least 1 enrollee from each of 3 racial/ethnic groups: Hispanics, (non-Hispanic) blacks, and (non-Hispanic) whites. Our primary study population consisted of a stratified random sample of approximately equal number of each racial/ethnic group from each zip code with racial/ethnic diversity (N=1,563,631). We identified ED visits, comorbidities, primary-care-treatable status, and patient disposition. We characterized socioeconomic status by zip code poverty rate. The main outcome measure was the ratio of ED visit rate (number of visits/100 person-years) between each minority group and whites. RESULTS Of 38,423 zip codes nationally, 41% met the racial/ethnic diversity criterion; these zip codes contained 85% of the Medicare fee-for-service beneficiaries. Among enrollees from zip codes with racial/ethnic diversity, the ED visit rate among whites was 45.4 (95% confidence interval 45.1 to 45.6), and the ED visit rate ratio was 1.34 (95% confidence interval 1.33 to 1.36) among blacks and 1.23 (95% confidence interval 1.22 to 1.24) among Hispanics. ED visit rate ratios for both minority groups were greater than 1.00 among all subgroups by age, comorbidity, zip code poverty rate, urban/rural area, and primary-care-treatable and disposition status. CONCLUSION Among Medicare enrollees, blacks and Hispanics had higher ED use rates than whites overall and among subgroups by demographics and socioeconomic status.
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Brown JF, Raven MC, Tangherlini NL, Kennedy Hall M. Frequent Users of 9-1-1 Emergency Medical Services: Sign of Success or Symptom of Impending Failure? PREHOSP EMERG CARE 2018; 23:1-3. [PMID: 30130427 DOI: 10.1080/10903127.2018.1475531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
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21
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Riney LC, Brokamp C, Beck AF, Pomerantz WJ, Schwartz HP, Florin TA. Emergency Medical Services Utilization Is Associated With Community Deprivation in Children. PREHOSP EMERG CARE 2018; 23:225-232. [PMID: 30118621 DOI: 10.1080/10903127.2018.1501124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pediatric emergency medical services (EMS) utilization is costly and resource intensive; significant variation exists across large-scale geographies. Less is known about variation at smaller geographic levels where factors including lack of transportation, low health literacy, and decreased access to medical homes may be more relevant. Our objective was to determine whether pediatric EMS utilization varied across Hamilton County, Ohio, census tracts and whether such utilization was associated with socioeconomic deprivation. METHODS This was a retrospective analysis of children living in Hamilton County, Ohio, transported by EMS to the Cincinnati Children's emergency department between July 1, 2014, and July 31, 2016. Participants' addresses were assigned to census tracts and an EMS utilization rate and deprivation index were calculated for each. Pearson's correlation coefficients evaluated relationships between tract-level EMS utilization and deprivation. Tract-level deprivation was used as a predictor in patient-level evaluations of acuity. RESULTS During the study period, there were 4,877 pediatric EMS transports from 219 of the 222 county census tracts. The county EMS utilization rate during the study period was 2.4 transports per 100 children (range 0.2-11). EMS utilization rates were positively correlated with increasing deprivation (r = 0.72, 95% confidence interval [CI], 0.65-0.77). Deprivation was associated with lower illness severity at triage, fewer transports resulting in resuscitation suite use, and fewer transports resulting in hospitalizations (all p < 0.05). CONCLUSIONS EMS utilization varied substantially across census tracts in Hamilton County, Ohio. A deeper understanding into why certain socioeconomically deprived areas contribute to disproportionately high rates of EMS utilization could support development of targeted interventions to improve use.
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