Cargando…
Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021
IMPORTANCE: The health care system has undergone major changes in the past decade, and emergency department (ED) crowding has worsened over time; however, the most recent patterns in ED capacity and use in California have yet to be studied. OBJECTIVE: To analyze patterns in ED capacity and utilizati...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288334/ https://www.ncbi.nlm.nih.gov/pubmed/37347481 http://dx.doi.org/10.1001/jamanetworkopen.2023.19438 |
_version_ | 1785062063291236352 |
---|---|
author | Hsia, Renee Y. Zagorov, Stefany Sarkar, Nandita Savides, Michael T. Feldmeier, Madeline Addo, Newton |
author_facet | Hsia, Renee Y. Zagorov, Stefany Sarkar, Nandita Savides, Michael T. Feldmeier, Madeline Addo, Newton |
author_sort | Hsia, Renee Y. |
collection | PubMed |
description | IMPORTANCE: The health care system has undergone major changes in the past decade, and emergency department (ED) crowding has worsened over time; however, the most recent patterns in ED capacity and use in California have yet to be studied. OBJECTIVE: To analyze patterns in ED capacity and utilization in California hospitals from 2011 to 2021. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the California Department of Health Care Access and Information and the US Census Bureau to analyze ED facility characteristics from more than 400 general acute care hospitals with more than 320 EDs in California as well as patients who presented to those EDs between January 1, 2011, and December 31, 2021. MAIN OUTCOMES AND MEASURES: Linear patterns (measured by percentage change) in total annual ED capacity (volume of hospital beds, EDs, ED treatment stations, and trauma centers) and ED use (ED visits by disposition and acuity) were assessed as primary outcomes. Patterns in ambulance diversion hours and the number of patients who left the ED without being seen were also examined as secondary outcomes. Visit acuity was categorized into 5 levels by increasing severity (minor, low to moderate, moderate, severe without threat, and severe with threat) based on California Department of Health Care Access and Information descriptions corresponding to Current Procedural Terminology codes. RESULTS: In the prepandemic period (2011-2019), the total population of California increased from 37 638 369 to 39 512 223 (5.0%; 95% CI, 4.1%-5.8%), then decreased to 39 237 836 in 2021 (0.7%; 95% CI, −3.9% to 2.5%). Over the entire study period (2011-2021), the total California population increased by 4.2% (95% CI, 3.3%-5.2%). From 2011 to 2019, the annual number of ED visits increased from 12 054 885 to 14 876 653 (23.4%; 95% CI, 20.0%-26.8%) before decreasing to 12 944 692 in 2021 (−13.0%; 95% CI, −33.1% to 7.1%); from 2011 to 2021, total ED visits increased by 7.4% (95% CI, 5.6%-9.1%). From 2011 to 2021, the total number of EDs decreased from 339 to 326 (−3.8%; 95% CI, −4.4% to −3.2%) and the total number of hospital beds decreased from 75 940 to 74 052 (−2.5%; 95% CI, −3.3% to −1.6%), while the number of ED treatment stations in these fewer EDs increased from 7159 to 8667 (21.1%; 95% CI, 19.7%-22.4%). The number of visits rated as severe with threat also increased, from 2 011 637 in 2011 to 3 375 539 in 2021 (67.8%; 95% CI, 59.7%-75.9%), while visits rated as minor decreased from 913 712 to 336 071 (−63.2%; 95% CI, −75.2% to −51.2%) over the same period. CONCLUSIONS AND RELEVANCE: In this cohort study, multiple measures of ED capacity did not proportionally increase with the increasing demand for services; however, the COVID-19 pandemic appears to have substantially affected some of these patterns. These findings may be helpful to policy makers and health care stakeholders when planning resource allocation of limited health care resources. |
format | Online Article Text |
id | pubmed-10288334 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-102883342023-06-24 Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021 Hsia, Renee Y. Zagorov, Stefany Sarkar, Nandita Savides, Michael T. Feldmeier, Madeline Addo, Newton JAMA Netw Open Original Investigation IMPORTANCE: The health care system has undergone major changes in the past decade, and emergency department (ED) crowding has worsened over time; however, the most recent patterns in ED capacity and use in California have yet to be studied. OBJECTIVE: To analyze patterns in ED capacity and utilization in California hospitals from 2011 to 2021. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the California Department of Health Care Access and Information and the US Census Bureau to analyze ED facility characteristics from more than 400 general acute care hospitals with more than 320 EDs in California as well as patients who presented to those EDs between January 1, 2011, and December 31, 2021. MAIN OUTCOMES AND MEASURES: Linear patterns (measured by percentage change) in total annual ED capacity (volume of hospital beds, EDs, ED treatment stations, and trauma centers) and ED use (ED visits by disposition and acuity) were assessed as primary outcomes. Patterns in ambulance diversion hours and the number of patients who left the ED without being seen were also examined as secondary outcomes. Visit acuity was categorized into 5 levels by increasing severity (minor, low to moderate, moderate, severe without threat, and severe with threat) based on California Department of Health Care Access and Information descriptions corresponding to Current Procedural Terminology codes. RESULTS: In the prepandemic period (2011-2019), the total population of California increased from 37 638 369 to 39 512 223 (5.0%; 95% CI, 4.1%-5.8%), then decreased to 39 237 836 in 2021 (0.7%; 95% CI, −3.9% to 2.5%). Over the entire study period (2011-2021), the total California population increased by 4.2% (95% CI, 3.3%-5.2%). From 2011 to 2019, the annual number of ED visits increased from 12 054 885 to 14 876 653 (23.4%; 95% CI, 20.0%-26.8%) before decreasing to 12 944 692 in 2021 (−13.0%; 95% CI, −33.1% to 7.1%); from 2011 to 2021, total ED visits increased by 7.4% (95% CI, 5.6%-9.1%). From 2011 to 2021, the total number of EDs decreased from 339 to 326 (−3.8%; 95% CI, −4.4% to −3.2%) and the total number of hospital beds decreased from 75 940 to 74 052 (−2.5%; 95% CI, −3.3% to −1.6%), while the number of ED treatment stations in these fewer EDs increased from 7159 to 8667 (21.1%; 95% CI, 19.7%-22.4%). The number of visits rated as severe with threat also increased, from 2 011 637 in 2011 to 3 375 539 in 2021 (67.8%; 95% CI, 59.7%-75.9%), while visits rated as minor decreased from 913 712 to 336 071 (−63.2%; 95% CI, −75.2% to −51.2%) over the same period. CONCLUSIONS AND RELEVANCE: In this cohort study, multiple measures of ED capacity did not proportionally increase with the increasing demand for services; however, the COVID-19 pandemic appears to have substantially affected some of these patterns. These findings may be helpful to policy makers and health care stakeholders when planning resource allocation of limited health care resources. American Medical Association 2023-06-22 /pmc/articles/PMC10288334/ /pubmed/37347481 http://dx.doi.org/10.1001/jamanetworkopen.2023.19438 Text en Copyright 2023 Hsia RY et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Hsia, Renee Y. Zagorov, Stefany Sarkar, Nandita Savides, Michael T. Feldmeier, Madeline Addo, Newton Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021 |
title | Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021 |
title_full | Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021 |
title_fullStr | Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021 |
title_full_unstemmed | Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021 |
title_short | Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021 |
title_sort | patterns in patient encounters and emergency department capacity in california, 2011-2021 |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288334/ https://www.ncbi.nlm.nih.gov/pubmed/37347481 http://dx.doi.org/10.1001/jamanetworkopen.2023.19438 |
work_keys_str_mv | AT hsiareneey patternsinpatientencountersandemergencydepartmentcapacityincalifornia20112021 AT zagorovstefany patternsinpatientencountersandemergencydepartmentcapacityincalifornia20112021 AT sarkarnandita patternsinpatientencountersandemergencydepartmentcapacityincalifornia20112021 AT savidesmichaelt patternsinpatientencountersandemergencydepartmentcapacityincalifornia20112021 AT feldmeiermadeline patternsinpatientencountersandemergencydepartmentcapacityincalifornia20112021 AT addonewton patternsinpatientencountersandemergencydepartmentcapacityincalifornia20112021 |