Effect of the Presence of Emergency Departments With ۳۰۰ or More Hospital Beds in Health Service Areas on ۳۰-Day Mortality in Korea: A Nationwide Retrospective Cross-sectional Study

Background  Disparities in emergency care accessibility exist between health service areas (HSAs). There is limited evidence on whether the presence of an emergency department (ED) that exceeds a certain hospital bed capacity is associated with emergency patient outcomes at the regional level. The objective of this study was to evaluate the effect of HSAs with or without of regional or local emergency centers with ۳۰۰ or more hospital beds (EC۳۰۰ or nEC۳۰۰, respectively) by comparing the ۳۰-day mortality of patients with severe emergency diseases (SEDs) admitted to the hospital through the ED. Methods  The study retrospectively evaluated data from the National Health Information Database (NHID) of the National Health Insurance Service (NHIS) Claims database and enrolled patients who were admitted from the ED for SEDs. SEDs were defined using ICD-۱۰ (International Classification of Diseases ۱۰th Revision) codes for ۲۸ disease categories with high severity, and ۵۶ HSAs were designated as published by the NHIS. We performed hierarchical logistic regression analysis using multilevel models with the generalized linear mixed model (GLIMMIX) procedure to evaluate whether EC۳۰۰ was associated with the ۳۰-day mortality of SED patients, adjusting for patient-level, prehospital-level, hospital-level, and HSA-level variables. Results  In total, ۶۶۲ ۴۷۸ patients were analyzed, of whom ۵۴ ۸۳۹ (۸.۳%) died within ۳۰ days after hospital discharge. Of the ۵۶ HSAs, ۴۶ (۸۲.۱%) were included in the EC۳۰۰ group. After adjustment for patient-level, prehospital-level, hospital-level, and HSA-level variables, nEC۳۰۰ was significantly associated with increased ۳۰-day mortality in SED patients (adjusted odds ratio [AOR]: ۱.۳۳, ۹۵% CI: ۱.۱۳۷-۱.۱۵۳). In addition, patients who visited EDs with fewer annual SED admissions were associated with higher ۳۰-day mortality. Conclusion  nEC۳۰۰ had a greater risk of ۳۰-day mortality in patients treated with SEDs than EC۳۰۰. The results indicate that not only the number of EDs in each HSA is important for ensuring adequate patient outcomes but also the presence of EDs with adequate receiving capacity.

Keywords:

Emergency Department , Health Services Accessibility , Healthcare Disparities , Health Services Administration , Health Service Area , Mortality