Which EDs are most likely to close?

Study details patient demographics, profit status of shuttered EDs

Hospital EDs that treat large numbers of minority and low-income patients face a greater risk of closing than other EDs, according to a study in the Annals of Emergency Medicine.

For the study, University of California-San Francisco researchers analyzed data from 1998 to 2008 from the Office of Statewide Health Planning and Development. During this time, about 7% of EDs in California closed.

The study found that financial factors, including how much a hospital relies on Medicaid payments, contributes to closures. For example, a 10% increase in Medicaid patients correlated with a 17% increase in risk of ED closure. In addition, the study found that a 10% increase in black patients increased the hospital's ED closure risk by 40%.

In addition, researchers found that for-profit hospitals had a 65% higher risk of closing their EDs than not-for-profit hospitals. According to the findings, for-profit EDs are more likely to close when economic conditions warrant closure than not-for-profit facilities.

Meanwhile, the study found that larger operating margins, faster hospital discharges, and a higher proportion of Medicare patients were correlated with lower ED closure risks. Hospitals were more likely to add ED capacity in suburban neighborhoods where patients had private insurance, the results showed.

According to the authors, ED closures can adversely affect patient outcomes and wait times, and cause ambulance diversions and more patients to leave without being seen. To avoiding further ED closures, they recommend expanding access to high- quality urgent care facilities, while bolstering primary care resources.

For example, they recommended that the health industry consider increasing the number of community health care centers, adding evening and weekend hours at facilities, and improving e-mail and phone communication between patients and providers (Barr, Modern Healthcare, 11/16 [subscription required]; Husted, "Shots," NPR, 11/16).

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