Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.
Emergency Departments (ED) are critical to the U.S. health care system, and ED closures can have a profound effect on a community. On one hand, prior literature has documented some adverse effects of ED closures. On the other hand, it has been posited that closures of EDs could improve acute care by removing poor-performers from the market. Moreover, permanent closure of a local ED could have an amplified effect for patients experiencing time-sensitive illnesses requiring prompt intervention, such as acute myocardial infarction (AMI). In this study using nationally representative data, we explore the mechanisms through which permanent ED closure affects patient access, treatment, and health outcomes in a community. Specifically, we compare changes in access to cardiac technology (availability of cath lab, cardiac care unit, and cardiac surgery capacity), treatment received (PTCA and thrombolytic therapy), and health outcomes (30-day, 90-day, and 1-year mortality, and 30-day all cause readmission) among Medicare AMI patients whose communities experience varying degrees of increase in driving time to their next available ED when the closest ED to the community shuts down, relative to patients from communities that do not experience any permanent ED closure.
In collaboration with Renee Hsia, UCSF.