Study: Calif. ED Closures Linked to Higher Patient Mortality Rates
California residents who live in an area where an emergency department has closed are more likely to die than those who have not been affected by an ED closure, according to a new study published in Health Affairs, Kaiser Health News' "Capsules" reports.
Nationally, the number of EDs decreased from 4,884 in 1996 to 4,594 in 2009 -- a 6% decline, according to the National Center for Health Statistics. Meanwhile, the number of ED admissions nationwide increased by about 51%, from 90.3 million to 136.1 million during that same time period (Caryn Rabin, "Capsules," Kaiser Health News, 8/4).
Details of Study
For the study, researchers from Harvard Medical School, UC-San Francisco and the Ecologic Institute in San Mateo analyzed data from OSHPD and other resources.
They identified 48 hospitals in California that closed their EDs between 1999 and 2010, including:
- 26 California hospitals with EDs that closed; and
- 22 California hospitals that remained open but closed their EDs (Kaplan, "Science Now," Los Angeles Times, 8/4).
They examined inpatient deaths among 16 million adult inpatients who were admitted to hospitals through EDs during that time period ("Capsules," Kaiser Health News, 8/4).
The study found that of the 16 million adult patients who were admitted to hospitals through EDs in California from 1999 to 2010, 25% were from neighborhoods affected by an ED closure.
In addition, the study found that ED closures were more likely to affect patients who were:
- Black or Latino;
- Enrolled in Medicaid;
- Under the age of 65; and
- Uninsured ("Science Now," Los Angeles Times, 8/4).
Overall, the researchers found that patients who had been affected by an ED closure were 5% more likely to die than patients who were not affected by such closures.
Among patients who were affected by an ED closure and were under the age of 65, the risk of dying was 10% higher ("Capsules," Kaiser Health News, 8/4). Further, among patients affected by an ED closure:
- Those experiencing sepsis were 8% more likely to die than patients who were not affected by a closure;
- Those experiencing a stroke were 10% more likely to die; and
- Those experiencing a heart attack were 15% more likely to die ("Science Now," Los Angeles Times, 8/4).
Researchers said that ED closures could contribute to higher death rates by:
- Causing patients to wait longer to receive necessary care because of distance or travel inconveniences;
- Forcing patients to travel greater distances to reach an ED; and
- Increasing crowding and longer wait times at EDs that remain open ("Capsules," Kaiser Health News, 8/4).