Shen Yu-Chu, Hsia Renee Y
Yu-Chu Shen (
Renee Y. Hsia is a professor in the Department of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco.
Health Aff (Millwood). 2015 Aug;34(8):1273-80. doi: 10.1377/hlthaff.2014.1462.
Ambulance diversion, which occurs when a hospital emergency department (ED) is temporarily closed to incoming ambulance traffic, is an important system-level interruption that causes delays in treatment and potentially lower quality of care. There is little empirical evidence investigating the mechanisms through which ambulance diversion might affect patient outcomes. We investigated whether ambulance diversion affects access to technology, likelihood of treatment, and ultimately health outcomes for Medicare patients with acute myocardial infarction in twenty-six California counties. We found that patients whose nearest hospital ED had significant ambulance diversions experienced reduced access to hospitals with cardiac technology. This led to a 4.6 percent decreased likelihood of revascularization and a 9.8 percent increase in one-year mortality compared to patients who did not experience diversion. Policy makers may wish to consider creating a policy to specifically manage certain time-sensitive conditions that require technological intervention during periods of ambulance diversion.
救护车分流是指医院急诊科暂时停止接收救护车送来的患者，这是一种重要的系统层面的干扰，会导致治疗延误并可能降低医疗质量。目前几乎没有实证证据来研究救护车分流可能影响患者治疗结果的机制。我们调查了加利福尼亚州26个县的急性心肌梗死医疗保险患者，救护车分流是否会影响他们获得技术的机会、接受治疗的可能性以及最终的健康结果。我们发现，其最近的医院急诊科出现大量救护车分流的患者，获得配备心脏技术医院的机会减少。与未经历分流的患者相比，这导致血管重建的可能性降低了4.6%，一年死亡率增加了9.8%。政策制定者不妨考虑制定一项政策，专门管理某些在救护车分流期间需要技术干预的对时间敏感的病症。
