Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea

Abstract

Increase in travel time, beyond a critical point, to emergency care may lead to a residential disparity in the outcome of patients with acute conditions. However, few studies have evaluated the evidence of travel time benchmarks in view of the association between travel time and outcome. Thus, this study aimed to establish the optimal hospital access time (OHAT) for emergency care in South Korea. We used nationwide healthcare claims data collected by the National Health Insurance System database of South Korea. Claims data of 445,548 patients who had visited emergency centers between January 1, 2006 and December 31, 2014 were analyzed. Travel time, by vehicle from the residence of the patient, to the emergency center was calculated. Thirteen emergency care–sensitive conditions (ECSCs) were selected by a multidisciplinary expert panel. The 30-day mortality after discharge was set as the outcome measure of emergency care. A change-point analysis was performed to identify the threshold where the mortality of ECSCs changed significantly. The differences in risk-adjusted mortality between patients living outside of OHAT and those living inside OHAT were evaluated. Five ECSCs showed a significant threshold where the mortality changed according to their OHAT. These were intracranial injury, acute myocardial infarction, other acute ischemic heart disease, fracture of the femur, and sepsis. The calculated OHAT were 71–80 min, 31–40 min, 70–80 min, 41–50 min, and 61–70 min, respectively. Those who lived outside the OHAT had higher risks of death, even after adjustment (adjusted OR: 1.04–7.21; 95% CI: 1.03–26.34). In conclusion, the OHAT for emergency care with no significant increase in mortality is in the 31–80 min range. Optimal travel time to hospital should be established by optimal time for outcomes, and not by geographic time, to resolve the disparities in geographical accessibility to emergency care.

The Relationship between Hospital Selection by Employer and Disabilities in Occupational Accidents in Korea

“…Conversely, in the non–Seoul capital area, the average capacity of hospitals is lower, and hospital selection by employers might have a greater impact on the prognosis for injured workers. In addition, the non–Seoul capital area has few hospitals, most of which are small, and the transportation network is relatively poor, making it difficult to transfer a patient after selecting an inappropriate hospital [ 43 , 44 ]. There is also a lack of long-term rehabilitation medical systems in the non–Seoul capital area [ 45 ].…”

Disparidades no acesso às terapias de reperfusão entre pacientes com IAMCSST da região não metropolitana e metropolitana de Aracaju

“…No entanto, ressalta-se que o município mais distante dentro do estado de Sergipe se encontra aproximadamente 3h de distância da capital, aproximadamente. Estudos internacionais apontaram menor atraso no acesso ao hospital quando comparado ao descrito neste registro (Jang et al, 2021;Yin et al, 2020;Balamurugan et al, 2018;Mendes et al, 2014). Todavia, nenhum deles descrevem o tempo quanto ao local de início dos sintomas.…”

“…Em Sergipe, esse panorama não é diferente, visto que todos os quatro hospitais com capacidade para realizar angioplastia primária estão situados na capital Aracaju, ademais apenas um hospital é referência cardiológica para usuários do SUS. Já existem estudos prévios internacionais que sugerem piores resultados para pacientes das regiões não metropolitanas quando comparados com os pacientes das regiões metropolitanas (Mathew et al, 2017;Ayad et al, 2021;Jang et al, 2021).…”

Doctors’ experiences of providing care in rural hospitals in Southern New Zealand: a qualitative study

“…Long distances to the nearest ED increase mortality risk for patients with specific emergency care-sensitive conditions: intracranial injury, acute myocardial infarction, other acute ischaemic heart disease, fracture of the femur and sepsis 33 34. In South Island, long distances to EDs are the rule rather than the exception, due to the dispersed population.…”