Renee Y. Hsia (
Yu-Chu Shen is a professor of economics in the Graduate School of Business and Public Policy, Naval Postgraduate School, in Monterey, California; and a faculty research fellow at the National Bureau of Economic Research, in Cambridge, Massachusetts.
Health Aff (Millwood). 2019 Sep;38(9):1496-1504. doi: 10.1377/hlthaff.2019.00125.
High-occupancy hospitals may be sensitive to neighboring emergency department (ED) closures and openings, as they already operate at or near capacity. We conducted a retrospective analysis using data for the period 2001-13 to examine outcomes of and treatment received by patients with acute myocardial infarction at so-called bystander EDs that had been exposed to nearby ED closures or openings. We used changes in driving time between an ED and the next-closest one as a proxy for a closure or opening: If driving time increased, for instance, it meant that a nearby ED had closed. When a high-occupancy ED was exposed to a closure that resulted in increased driving time of thirty minutes or more to the next-closest ED, one-year mortality and thirty-day readmission rates increased by 2.39 and 2.00 percentage points, respectively, while the likelihood of receiving percutaneous coronary intervention (PCI) declined by 2.06 percentage points. Exposure to ED openings that resulted in decreased driving times of thirty minutes or more was associated with reductions in thirty-day mortality at bystander hospitals and an increased likelihood of receiving PCI. Our findings suggest that limited resources at high-occupancy bystander hospitals make them sensitive to changes in the availability of emergency care in neighboring communities.
高入住率医院可能对附近急诊部（ED）的关闭和开放较为敏感，因为它们已经处于或接近满负荷运转。我们使用 2001 年至 2013 年的数据进行了回顾性分析，以检查所谓旁观者 ED 中急性心肌梗死患者的治疗结果和所接受的治疗，这些 ED 曾暴露于附近 ED 的关闭或开放之中。我们使用 ED 与最近的另一个 ED 之间的驾驶时间变化来作为关闭或开放的代理：例如，如果驾驶时间增加，这意味着附近的 ED 已经关闭。当高入住率 ED 面临导致到最近的 ED 的驾驶时间增加三十分钟或更长时间的关闭时，一年死亡率和三十天再入院率分别增加了 2.39%和 2.00%，而接受经皮冠状动脉介入治疗（PCI）的可能性则下降了 2.06%。暴露于 ED 开放，导致驾驶时间减少三十分钟或更长时间，与旁观者医院三十天死亡率降低和接受 PCI 的可能性增加有关。我们的发现表明，高入住率旁观者医院的有限资源使它们对邻近社区急诊服务的可用性变化较为敏感。
