Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use - A nationwide long-term observational study in Taiwan

Abstract

Background: The goal of this study was to examine the effect of hospital emergency department (ED) regionalization policy and the categorization of hospital emergency care policy (categorization policy) on patient appropriate ED use.Methods: We conducted an observational study of the effect of emergency care policy intervention on patients' visits. Seven years of data from the Taiwan National Health Insurance Research Database (NHIRD) were examined. Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization policies in 2007 and 2009, respectively. There were 1,835,860 ED visits found among one million random samples from the NHIRD between 2005 and 2011. ED visits were categorized by the modified New York University ED algorithm. A time series analysis was performed to examine the change in the rate of appropriate ED use after the policy took effect.Results: Total ED visits increased by 10.7% from 2005 to 2011. Average appropriate ED visit rate was 66.9% during the policy intervention. The trend in the appropriate ED visit rate showed no significant policy effect.Conclusions: Provider side of regionalization and categorization policies did increase emergency care accessibility. However, regionalization and categorization policies no significant effect on patient appropriate ED use.

Health Policy Spotlight Effects on Critical Time-Sensitive Diseases: Evidence from Taiwan Categorization of Hospital Emergency Capability Policy

“…The LHID2005 was validated as representative of medical utilization, as well as of diagnosis and treatment process and outcome quality for CTSDs 21 . This nationwide observational study investigates the impact of the CHEC policy, initiated in August 2009, which integrated 190 hospitals into a network focusing on acute conditions like stroke, myocardial infarction, major trauma, and perinatal care 22 . We divided our analysis into two periods: pre-CHEC (August 1, 2005 -July 31, 2009) and post-CHEC (August 1, 2009 - July 31, 2011).…”

Policy Spotlight Effect In Critical Time-Sensitive Diseases

“…In Taiwan, the CHEC policy was initially implemented in 2007 as a trial comprising the designation and regionalization of emergency rescuer-responsive hospitals and subsequently formally implemented in 2009 [15] The policy focuses on acute stroke, acute myocardial infarction, major trauma, and critical perinatal conditions at a hospital level, including ED, critical time-sensitive disease care team, and intensive care unit (ICU).…”

Policy Spotlight Effect in Critical Time-Sensitive Diseases

“…In Taiwan, the CHEC policy was initially implemented in 2007 as a trial comprising the designation and regionalization of emergency rescuerresponsive hospitals and subsequently formally implemented in 2009 [15] The policy focuses on acute stroke, acute myocardial infarction, major trauma, and critical perinatal conditions at a hospital level, including ED, critical time-sensitive disease care team, and intensive care unit (ICU).…”