Impact of integrated health system changes, accelerated due to an earthquake, on emergency department attendances and acute admissions: a Bayesian change-point analysis

Schluter, Philip J., Hamilton, Greg J., Deely, Joanne M. and Ardagh, Michael W. (2016) Impact of integrated health system changes, accelerated due to an earthquake, on emergency department attendances and acute admissions: a Bayesian change-point analysis. BMJ Open, 6 5: . doi:10.1136/bmjopen-2015-010709


Author Schluter, Philip J.
Hamilton, Greg J.
Deely, Joanne M.
Ardagh, Michael W.
Title Impact of integrated health system changes, accelerated due to an earthquake, on emergency department attendances and acute admissions: a Bayesian change-point analysis
Journal name BMJ Open   Check publisher's open access policy
ISSN 2044-6055
Publication date 2016-05-11
Year available 2016
Sub-type Article (original research)
DOI 10.1136/bmjopen-2015-010709
Open Access Status DOI
Volume 6
Issue 5
Total pages 10
Place of publication London, United Kingdom
Publisher B M J Group
Collection year 2017
Language eng
Formatted abstract
Objective: To chart emergency department (ED) attendance and acute admission following a devastating earthquake in 2011 which lead to Canterbury's rapidly accelerated integrated health system transformations.

Design: Interrupted time series analysis, modelling using Bayesian change-point methods, of ED attendance and acute admission rates over the 2008-2014 period.

Setting: ED department within the Canterbury District Health Board; with comparison to two other district health boards unaffected by the earthquake within New Zealand.

Participants: Canterbury's health system services ∼500 000 people, with around 85 000 ED attendances and 37 000 acute admissions per annum.

Main outcome measures: De-seasoned standardised population ED attendance and acute admission rates overall, and stratified by age and sex, compared before and after the earthquake.

Results: Analyses revealed five global patterns: (1) postearthquake, there was a sudden and persisting decrease in the proportion of the population attending the ED; (2) the growth rate of ED attendances per head of population did not change between the pre-earthquake and postearthquake periods; (3) postearthquake, there was a sudden and persisting decrease in the proportion of the population admitted to hospital; (4) the growth rate of hospital admissions per head of the population declined between pre-earthquake and postearthquake periods and (5) the most dramatic reduction in hospital admissions growth after the earthquake occurred among those aged 65+ years. Extrapolating from the projected and fitted deseasoned rates for December 2014, ∼676 (16.8%) of 4035 projected hospital admissions were avoided.

Conclusions: While both necessarily and opportunistically accelerated, Canterbury's integrated health systems transformations have resulted in a dramatic and sustained reduction in ED attendances and acute hospital admissions. This natural intervention experiment, triggered by an earthquake, demonstrated that integrated health systems with high quality out-of-hospital care models are likely to successfully curb growth in acute hospital demand, nationally and internationally.
Keyword Emergency department (ED) attendance
Integrated health system changes
Earthquake
Acute hospital admissions
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Nursing, Midwifery and Social Work Publications
 
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