Access Delayed Is Access Denied: Relationship Between Access to Trauma Center Care and Pre-Hospital Death

Hashmi, Zain G.; Jarman, Molly P.; Uribe-Leitz, Tarsicio; Goralnick, Eric; Newgard, Craig D.; Salim, Ali; Cornwell, Edward E.; Haider, Adil H.

doi:10.1016/j.jamcollsurg.2018.09.015

Cited by 46 publications

(54 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Measuring spatial accessibility can be done by calculating simple provider-to-population ratios, distances to the closest provider, or distances to the closest set of providers. Such measurements are commonly applied in health care research [ 7 , 8 ]. More developed measures of spatial accessibility are based on gravity models [ 6 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility

et al. 2020

View full text Add to dashboard Cite

Background: The adequate allocation of inpatient care resources requires assumptions about the need for health care and how this need will be met. However, in current practice, these assumptions are often based on outdated methods (e.g. Hill-Burton Formula). This study evaluated floating catchment area (FCA) methods, which have been applied as measures of spatial accessibility, focusing on their ability to predict the need for health care in the inpatient sector in Germany. Methods: We tested three FCA methods (enhanced (E2SFCA), modified (M2SFCA) and integrated (iFCA)) for their accuracy in predicting hospital visits regarding six medical diagnoses (atrial flutter/fibrillation, heart failure, femoral fracture, gonarthrosis, stroke, and epilepsy) on national level in Germany. We further used the closest provider approach for benchmark purposes. The predicted visits were compared with the actual visits for all six diagnoses using a correlation analysis and a maximum error from the actual visits of ± 5%, ± 10% and ± 15%. Results: The analysis of 229 million distances between hospitals and population locations revealed a high and significant correlation of predicted with actual visits for all three FCA methods across all six diagnoses up to ρ = 0.79 (p < 0.001). Overall, all FCA methods showed a substantially higher correlation with actual hospital visits compared to the closest provider approach (up to ρ = 0.51; p < 0.001). Allowing a 5% error of the absolute values, the analysis revealed up to 13.4% correctly predicted hospital visits using the FCA methods (15% error: up to 32.5% correctly predicted hospital). Finally, the potential of the FCA methods could be revealed by using the actual hospital visits as the measure of hospital attractiveness, which returned very strong correlations with the actual hospital visits up to ρ = 0.99 (p < 0.001). Conclusion: We were able to demonstrate the impact of FCA measures regarding the prediction of hospital visits in non-emergency settings, and their superiority over commonly used methods (i.e. closest provider). However, hospital beds were inadequate as the measure of hospital attractiveness resulting in low accuracy of predicted hospital visits. More reliable measures must be integrated within the proposed methods. Still, this study strengthens the possibilities of FCA methods in health care planning beyond their original application in measuring spatial accessibility.

show abstract

Section: Introductionmentioning

confidence: 99%

Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility

et al. 2020

View full text Add to dashboard Cite

show abstract

“…[1][2][3] The American College of Surgeons recently published a study concluding that 'access delayed is accessed denied'. 15 In their study, Hashmi et al demonstrated that among more than 1.9 million trauma patients, states with better access to trauma care had lower age-adjusted mortality. DA represents one strategy to help ensure the optimization of patient safety in trauma system care and potentially to improve outcomes.…”

Section: Discussionmentioning

confidence: 98%

Direct admission to improve timely access to care for patients requiring transfer to a level 1 trauma center

Safavi

Gaitanidis

Breen

et al. 2020

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundEmergency departments (EDs) at level 1 trauma centers are often overcrowded and deny ED-to-ED transfers from lower-tiered centers. Lack of access to timely level 1 care is associated with increased mortality. We evaluated the feasibility of a direct admission (DA) protocol as a method to increase timely access to a level 1 trauma center during periods of ED overcrowding.MethodsDuring periods of ED overcrowding between 1 May and 31 December 2019, we admitted patients from referring EDs directly to the intensive care unit (ICU) or inpatient ward using the DA protocol. In a prospective comparative study design, we compared their outcomes to patients during the same period who were admitted through the ED when the ED was not overcrowded.ResultsDuring periods of ED overcrowding, transfer was requested and clinically accepted for 28 patients, of which 23 (82.1%, age 63±20.3 years, men 52.2% men) were successfully admitted via the DA protocol. Five (17.9%) were not successfully transferred due to lack of available inpatient beds. During periods when the ED was not overcrowded, 106 patients (age 62.8±23.1 years, men 52.8%) were admitted via the ED. There were no morbidity or mortality events attributed to the DA process. Time to patient arrival was 2.7 hours (95% CI 2.3 to 3.1) in the DA cohort and 1.9 hours (95% CI 1.5 to 2.4) in the ED-to-ED cohort (p=0.104). Up-triage to the ICU within 24 hours was performed in only one patient (4.3%). In-hospital mortality did not differ (3 (13%) vs. 8 (7.6%), p=0.392).DiscussionThe DA pathway is a feasible method to safely transfer patients from a referring ED to a higher-care trauma center when its ED is overcrowded.Level of evidenceLevel III, care management.

show abstract

“…A recent study by Hashmi et al 16 examining access to trauma care and prehospital death found that state by state disparities exist in age-adjusted mortality rate. To address these disparities, Bailed person fees OH 2 OH: §4513.263(E) requires that the trauma and emergency medical services fund be satisfied with monies from (1) "(a)pplication fees for certificates of accreditation, certificates of approval, certificates to teach, and certificates to practice"; funds from fees and fines assessed as part of the fire service training program; fees and fines assessed for operation of emergency medical, fire, transportation, and ambulance services; as well as "(f)orty-five per cent of the fines collected from or moneys arising from bail forfeited by persons apprehended or arrested by state highway patrol troopers…".…”

Section: Discussionmentioning

confidence: 99%

Trauma system funding: implications for the surgeon health policy advocate

Lin

Johnson

Opelka

et al. 2020

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundTrauma systems improve mortality for the most severely injured patients; however, these systems are managed by individual states with different funding mechanisms, which can lead to inconsistencies in the quality of care. This study compiles trauma system legislation and regulations of funding sources and creates a trauma funding categorization system. Such data help to inform the systems of trauma care delivery within and between states.MethodsOnline searches of state statutes were performed to establish the presence of legislative code to establish a trauma system, the presence of legislative code that funds these trauma systems, and the amount of funding that was allocated to each state’s trauma system in fiscal year 2016 to 2017. Following this, each state’s trauma system was contacted via email and telephone to further obtain this information.ResultsSpecific state legislation creating a trauma system was identified in 48 states (96%). Data for categorization of trauma system funding were obtained in 30 states (60%). Of these 30 states, 29 have legislation funding their trauma systems. 17 states funded their trauma systems through general appropriations legislation, 10 states used percentages of fines from criminal and misdemeanor offenses, and 7 states used fees and taxes. New York state does not have any specific funding legislation. Individual state financial contributions to state trauma systems ranged from $55 000 to $25 899 450, annually.DiscussionThere is a limited amount of trauma system funding details available, and among these there is wide variation of funding source types and amounts allotted toward trauma systems. It is difficult to obtain and summate legislative information for use for surgical health policy advocacy efforts. Further study and method development to disseminate comprehensive and comparative legislative and regulatory data and information to physicians and other trauma system stakeholders are needed.Level of evidenceIII, economic and valued-based evaluation; analyses based on limited alternatives and costs; poor estimates.

show abstract

Access Delayed Is Access Denied: Relationship Between Access to Trauma Center Care and Pre-Hospital Death

Cited by 46 publications

References 25 publications

Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility

Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility

Direct admission to improve timely access to care for patients requiring transfer to a level 1 trauma center

Trauma system funding: implications for the surgeon health policy advocate

Contact Info

Product

Resources

About