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Health Serv Res. 2019 Aug;54(4):870-879. doi: 10.1111/1475-6773.13147. Epub 2019 Apr 2.

Ambulance diversions following public hospital emergency department closures.

Author information

1
Department of Health Policy and Administration, Penn State University, University Park, Pennsylvania.
2
Department of Emergency Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California.
3
School of Law, University of California, Los Angeles, Los Angeles, California.
4
Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, California.

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.

KEYWORDS:

access to care; ambulance diversion; emergency department

PMID:
30941753
PMCID:
PMC6606538
[Available on 2020-08-01]
DOI:
10.1111/1475-6773.13147

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