title: The effect of the development of an emergency transfer system on the travel time to tertiary care centres in Japan.
abstract: BACKGROUND
  In Japan, the emergency medical system is categorized into three levels: primary, secondary, and tertiary, depending on the severity of the condition of the patient. Tertiary care centres accept patients who require 24-h monitoring. In this research, the average travel times (minutes) from the centroids of all municipalities in Japan to the nearest tertiary care centre were estimated, using the geographic information system. The systems affecting travel time to tertiary care centres were also examined. Regression analysis was performed to determine the factors affecting the travel time to tertiary care centres, using selected variables representing road conditions and the emergency transfer system. Linear regression analysis was performed to identify specific benchmarks that would be effective in reducing the average travel time to tertiary care centres in prefectures with travel times longer than the average 57 min.
  
  
  RESULTS
  The mean travel time was 57 min, the range was 83 min, and the standard deviation was 20.4. As a result of multiple regression analysis, average coverage area per tertiary care centre, kilometres of highway road per square kilometre, and population were selected as variables with impact on the average travel time. Based on results from linear regression analysis, benchmarks for the emergency transfer system that would effectively reduce travel time to the mean value of 57 min were identified: 26% pavement ratio of roads (percentage of paved road to general roads), and three tertiary care centres and 108 ambulances.
  
  
  CONCLUSIONS
  Regional gaps in the travel time to tertiary care centres were identified in Japan. The systems we should focus on to reducing travel time were identified. Further reduction of travel time to tertiary care centres can be effectively achieved by improving these specific systems. Linear regression analysis showed that a 26% pavement ratio and three tertiary care centres are beneficial to prefectures with an average time longer than the mean score, to achieve a reduction of travel time. Measures for reducing travel time need to be considered in policy-making to re-evaluate the current locations of tertiary care centres to provide equality of access to emergency medicine.
authors.affiliation: Department of Health Policy Science, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan. makiko@meno-sg.net
authors.forename: Makiko
authors.initials: M
authors.lastname: Miwa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawaguchi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Arima
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kawahara
mesh_terms: D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000145:classification / Q000706:statistics & numerical data*; D040362:Geographic Information Systems; D006801:Humans; D007564:Japan; D011156:Population Density; D012044:Regression Analysis; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*