Factors Associated with Ambulance Use Among Patients with Low-Acuity Conditions

Durant, Edward; Fahimi, Jahan

doi:10.3109/10903127.2012.670688

Cited by 71 publications

(70 citation statements)

References 25 publications

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“…Most patients causing self-induced injury often have psychological diseases,16 and medical staff in non-psychiatric emergency departments might refuse the request from EMS personnel to receive such patients because of the difficulty in treating them. In addition, these patients tend to call for ambulances and frequently visit emergency departments,17–19 which might also affect the difficulty in hospital acceptance. Trauma by assault was also one of the predictors of the difficulty in hospital acceptance at the scene, and emergency hospitals would hesitate to receive patients with such injuries because there are not emergency hospitals for the emergency transport of these patients by law in Japan, and it is difficult for staff to continuously monitor them in hospitals.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan

et al. 2016

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ObjectivesTo investigate the association between the difficulty in hospital acceptance at the scene by emergency medical service (EMS) personnel and prehospital demographic factors and reasons for EMS calls.DesignA retrospective, observational study.SettingOsaka City, Japan.ParticipantsA total of 100 649 patients transported to medical institutions by EMS from January 2013 to December 2013.Primary outcome measurementsThe definition of difficulty in hospital acceptance at the scene was EMS personnel making ≥5 phone calls to medical institutions until a decision to transport was determined. Multivariable analysis was used to assess the relationship between difficulty in hospital acceptance and prehospital factors and reasons for EMS calls.ResultsMultivariable analysis showed the elderly, foreigners, loss of consciousness, holiday/weekend, and night-time to be positively associated with difficulty in hospital acceptance at the scene. As reasons for EMS calls, gas poisoning (adjusted OR 3.281, 95% CI 1.201 to 8.965), trauma by assault (adjusted OR 2.662, 95% CI 2.390 to 2.966), self-induced drug abuse/gas poisoning (adjusted OR 4.527, 95% CI 3.921 to 5.228) and self-induced trauma (adjusted OR 1.708, 95% CI 1.369 to 2.130) were positively associated with the difficulty in hospital acceptance at the scene.ConclusionsAmbulance records in Osaka City showed that certain prehospital factors such as night-time were positively associated with difficulty in hospital acceptance at the scene, and reasons for EMS calls, such as self-induced drug abuse/gas poisoning, were also positive predictors for difficulty in hospital acceptance at the scene.

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Section: Discussionmentioning

confidence: 99%

Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan

et al. 2016

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“…This is consistent with evidence of access barriers in the use of ambulance and ED services in the form of limited transport alternatives, health literacy, and English proficiency. 39–45 In assessing the implications of differential ambulance use, we note that there is “no expert consensus on what constitutes medical necessity for ambulance use” and perception of emergent need may vary. 39,46 Evidence indicates that ambulance use is associated with improved patient outcomes, particularly for time-sensitive acute medical events, such as, stroke, 8 myocardial infarction, cardiac arrest 11 and respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…Given that much of the current evidence on ambulance use is based on NHAMCS data, which is a survey of ED patients, our findings indicate that the patterns on ambulance use obtained from NHAMCS data may not be representative of population-level patterns in use of ambulance. 5,7,39,44,47 …”

Section: Discussionmentioning

confidence: 99%

Geographic Variation in Use of Ambulance Transport to the Emergency Department

Hanchate

Dyer

Baker

et al. 2017

Annals of Emergency Medicine

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Context Evidence on variability in emergency medical services (EMS) use is limited. Objective To obtain national evidence on geographic variation in the use of ambulance transport to the emergency department (ED) among Medicare enrollees, and assess the role of health status, socioeconomic status (SES) and provider availability. Design, Setting, and Participants We used 2010 Medicare claims data for a random sample of 999,999 enrollees aged 66 and older, and identified ambulance transport and ED use. Main Outcomes Measures Number of ambulance transports to ED per 100 person-years (ambulance transport rate) and proportion (%) of ED visits by ambulance transport by hospital referral regions (HRR). Results The national ambulance transport rate was 22.2 and the overall proportion of ED visits by ambulance was 36.7%. Relative to HRRs in the lowest rate quartile, HRRs in the highest quartile had a 75% higher ambulance transport rate (incidence rate ratio (IRR), 1.75; 95% confidence interval (CI) = [1.69, 1.81]) and a 15.5% higher proportion of ED visits by ambulance (IRR, 1.155; 95% CI = [1.146, 1.164]). Adjusting for health status, SES, and provider availability reduced quartile 1 vs. quartile 4 difference in ambulance transport rate by 43% (IRR, 1.43; 95% CI = [1.38, 1.48]) and proportion of ED visits by ambulance by 7% (IRR, 1.145; 95% CI = [1.135, 1.155]). Among the three covariate domains, health status was associated with the largest variability in ambulance transport rate (30.1%), followed by SES (12.8%) and provider availability (2.9%). Conclusion Geographic variability in ambulance use is large, and associated with variation in patient health status and SES.

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“…We found the superuser population was represented by a much higher proportion of Medicaid recipients that the average 2009 EMS population, which has important implications for state Medicaid agencies attempting to reduce expenditures. Previous studies have demonstrated that publicly insured individuals disproportionally use ambulance transport and ED services, 25,30 especially for low-acuity conditions 31 or alcohol-related disorders. 25 However, in many communities EMS personnel are left with no alternative transport destination apart from the ED.…”

Section: Discussionmentioning

confidence: 99%

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Hall¹,

Raven²,

Hall³

et al. 2014

Prehospital Emergency Care

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Objective. Emergency medical services (EMS) "superusers" -those who use EMS services at extremely high rateshave not been well characterized. Recent interest in the small group of individuals who account for a disproportionate share of health-care expenditures has led to research on frequent users of emergency departments and other health services, but little research has been done regarding those who use EMS services. To inform policy and intervention implementation, we undertook a descriptive analysis of EMS superusers in a large urban community. In this paper we compare EMS superusers to low, moderate, and high users to characterize factors contributing to EMS use. We also estimate the financial impact of EMS superusers. Methods. We conducted a retrospective cross-sectional study based on 1 year of data from an urban EMS system. Data for all EMS encounters with patients age ≥18 years were extracted from electronic records generated on scene by paramedics. We identified demographic and clinical variables associated with levels of EMS use. EMS users were characterized by the annual number of EMS encounters: low (1), moderate (2-4), high (5-14), and superusers (≥15). In addition, we performed a financial analysis using San Francisco Fire Department of 31,462 adults generated 43,559 EMS ambulance encounters, which resulted in 39,107 transports (a 90% transport rate). Encounters for general medical reasons were common among moderate and high users and less frequent among superusers and low users, while alcohol use was exponentially correlated with encounter frequency. Superusers were significantly younger than moderate EMS users, and more likely to be male. The superuser group created a significantly higher financial burden/person than any other group, comprising 0.3% of the study population, but over 6% of annual EMS charges and reimbursements. Conclusions. In this retrospective study, adult EMS "superusers" emerged as a distinct, predominantly male population and their EMS encounters were associated with alcohol use. Continued analysis of this unique, high-cost, and frequently transported population will likely illuminate specific intervention strategies.

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Factors Associated with Ambulance Use Among Patients with Low-Acuity Conditions

Cited by 71 publications

References 25 publications

Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan

Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan

Geographic Variation in Use of Ambulance Transport to the Emergency Department

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

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