title: The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis.
abstract: Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.
authors: 1 Department of Emergency Medicine, New York University School of Medicine , New York, New York.|2 Department of Population Health, New York University School of Medicine , New York, New York.|3 Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania , Philadelphia, Pennsylvania.|4 Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania.
authors: David C
authors: DC
authors: Lee
authors: 5 Department of Emergency Medicine, Kimmel School of Medicine, Thomas Jefferson University , Philadelphia, Pennsylvania.|6 Emergency Care Coordination Center , Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC.
authors: Brendan G
authors: BG
authors: Carr
authors: 7 Department of Electrical and Systems Engineering, University of Pennsylvania , Philadelphia, Pennsylvania.
authors: Tony E
authors: TE
authors: Smith
authors: 8 Department of Sociology, Columbia University , New York, New York.
authors: Van C
authors: VC
authors: Tran
authors: 4 Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania.|9 Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.|10 Department of Health Care Management, The Wharton School, University of Pennsylvania , Philadelphia, Pennsylvania.
authors: Daniel
authors: D
authors: Polsky
authors: 4 Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania.|11 Department of Biostatistics and Epidemiology, University of Pennsylvania , Philadelphia, Pennsylvania.|12 Cartographic Modeling Laboratory, University of Pennsylvania , Philadelphia, Pennsylvania.
authors: Charles C
authors: CC
authors: Branas
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006271:Health Facility Closure / Q000639:trends*; D006801:Humans; D009519:New York City; D011159:Population Surveillance; D012189:Retrospective Studies