title: Does decreased access to emergency departments affect patient outcomes? Analysis of acute myocardial infarction population 1996-2005.
abstract: OBJECTIVE
  We analyze whether decreased emergency department (ED) access results in adverse patient outcomes or changes in the patient health profile for patients with acute myocardial infarction (AMI).
  
  
  METHODS
  We merge Medicare claims, American Hospital Association annual surveys, Medicare hospital cost reports, and location information for 1995-2005.
  
  
  METHODS
  We define four ED access change categories and estimate a ZIP Code fixed-effects regression models on the following AMI outcomes: mortality rates, age, and probability of percutaneous transluminal coronary angioplasty (PTCA) on day of admission.
  
  
  RESULTS
  We find a small increase in 30-day to 1-year mortality rates among patients in communities that experience a <10-minute increase in driving time. Among patients in communities with >30-minute increases, we find a substantial increase in long-term mortality rates, a shift to younger ages (suggesting that older patients die en route), and a higher probability of immediate PTCA. Most of the adverse effects disappear after the transition years.
  
  
  CONCLUSIONS
  Deterioration in geographic access to ED affects a small segment of the population, and most adverse effects are transitory. Policy planners can minimize the adverse effects by providing assistance to ensure adequate capacity of remaining EDs, and facilitating the realignment of health care resources during the critical transition periods.
authors.affiliation: Graduate School of Business and Public Policy, Naval Postgraduate School, National Bureau of Economic Research, 555 Dyer Road, Monterey, CA 93943, USA. yshen@nps.edu
authors.forename: Yu-Chu
authors.initials: YC
authors.lastname: Shen
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D017130:Angioplasty / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006271:Health Facility Closure / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D014481:United States / Q000453:epidemiology
references.citation: Acad Emerg Med. 2003 Jul;10(7):709-16
references.pmid: 12837644
references.citation: Adv Data. 2007 Jun 29;(386):1-32
references.pmid: 17703794
references.citation: Ann Emerg Med. 2004 Dec;44(6):577-85
references.pmid: 15573032
references.citation: Ann Emerg Med. 2008 Jan;51(1):1-5
references.pmid: 17913299
references.citation: Acad Emerg Med. 2001 Nov;8(11):1013-5
references.pmid: 11691659
references.citation: Natl Health Stat Report. 2010 Aug 6;(26):1-31
references.pmid: 20726217
references.citation: J Am Geriatr Soc. 2006 Feb;54(2):270-5
references.pmid: 16460378
references.citation: Ann Emerg Med. 2007 Nov;50(5):510-6
references.pmid: 17913298
references.citation: J Health Econ. 2006 Jul;25(4):740-61
references.pmid: 16356570
references.citation: J Health Econ. 2009 Sep;28(5):924-37
references.pmid: 19781802
references.citation: Rev Econ Stat. 2015 Dec;97(5):951-964
references.pmid: 26989267
references.citation: Am J Emerg Med. 2006 Nov;24(7):787-94
references.pmid: 17098098
references.citation: Med Care Res Rev. 1995 Nov;52(4):532-42
references.pmid: 10153313
references.citation: JAMA. 1994 Sep 21;272(11):859-66
references.pmid: 8078163