Ambulance Diversions Following Public Hospital Emergency Department Closures

Overview

Journal Health Serv Res

Specialty Health Services

Date 2019 Apr 4

PMID 30941753

Citations 8

Authors

Charleen Hsuan

Renee Y Hsia

Jill R Horwitz

Ninez A Ponce

Thomas Rice

Jack Needleman

Affiliations

Soon will be listed here.

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.

Citing Articles

Racial and ethnic disparities in emergency department transfers to public hospitals.

Hsuan C, Vanness D, Zebrowski A, Carr B, Norton E, Buckler D Health Serv Res. 2024; 59(2):e14276.

PMID: 38229568 PMC: 10915485. DOI: 10.1111/1475-6773.14276.

A Conceptual Framework for Optimizing the Equity of Hospital-Based Emergency Care: The Structure of Hospital Transfer Networks.

Hsuan C, Carr B, Vanness D, Wang Y, Leslie D, Dunham E Milbank Q. 2023; 101(1):74-125.

PMID: 36919402 PMC: 10037699. DOI: 10.1111/1468-0009.12609.

Association of emergency department crowding with inpatient outcomes.

Hsuan C, Segel J, Hsia R, Wang Y, Rogowski J Health Serv Res. 2022; 58(4):828-843.

PMID: 36156243 PMC: 10315392. DOI: 10.1111/1475-6773.14076.

Ambulance diversion and ED destination by race/ethnicity: evaluation of Massachusetts' ambulance diversion ban.

Hanchate A, Baker W, Paasche-Orlow M, Feldman J BMC Health Serv Res. 2022; 22(1):987.

PMID: 35918721 PMC: 9347077. DOI: 10.1186/s12913-022-08358-8.

Title: advancing urban health equity in the United States in an age of health care gentrification: a framework and research agenda.

Cole H, Franzosa E Int J Equity Health. 2022; 21(1):66.

PMID: 35546673 PMC: 9092322. DOI: 10.1186/s12939-022-01669-6.

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