Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea.
Increase in travel time, beyond a critical point, to emergency care may lead to a residential disparity in the outcome of patients with acute conditions. However, few studies have evaluated the evidence of travel time benchmarks in view of the association between travel time and outcome. Thus, this...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2021-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0251116&type=printable |
| _version_ | 1826554494515675136 |
|---|---|
| author | Won Mo Jang Juyeon Lee Sang Jun Eun Jun Yim Yoon Kim Mi Young Kwak |
| author_facet | Won Mo Jang Juyeon Lee Sang Jun Eun Jun Yim Yoon Kim Mi Young Kwak |
| author_sort | Won Mo Jang |
| collection | DOAJ |
| description | Increase in travel time, beyond a critical point, to emergency care may lead to a residential disparity in the outcome of patients with acute conditions. However, few studies have evaluated the evidence of travel time benchmarks in view of the association between travel time and outcome. Thus, this study aimed to establish the optimal hospital access time (OHAT) for emergency care in South Korea. We used nationwide healthcare claims data collected by the National Health Insurance System database of South Korea. Claims data of 445,548 patients who had visited emergency centers between January 1, 2006 and December 31, 2014 were analyzed. Travel time, by vehicle from the residence of the patient, to the emergency center was calculated. Thirteen emergency care-sensitive conditions (ECSCs) were selected by a multidisciplinary expert panel. The 30-day mortality after discharge was set as the outcome measure of emergency care. A change-point analysis was performed to identify the threshold where the mortality of ECSCs changed significantly. The differences in risk-adjusted mortality between patients living outside of OHAT and those living inside OHAT were evaluated. Five ECSCs showed a significant threshold where the mortality changed according to their OHAT. These were intracranial injury, acute myocardial infarction, other acute ischemic heart disease, fracture of the femur, and sepsis. The calculated OHAT were 71-80 min, 31-40 min, 70-80 min, 41-50 min, and 61-70 min, respectively. Those who lived outside the OHAT had higher risks of death, even after adjustment (adjusted OR: 1.04-7.21; 95% CI: 1.03-26.34). In conclusion, the OHAT for emergency care with no significant increase in mortality is in the 31-80 min range. Optimal travel time to hospital should be established by optimal time for outcomes, and not by geographic time, to resolve the disparities in geographical accessibility to emergency care. |
| first_indexed | 2024-12-22T22:19:23Z |
| format | Article |
| id | doaj.art-7c790b72ab5a45b3829fb2d13c00a643 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2025-03-14T07:41:48Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-7c790b72ab5a45b3829fb2d13c00a6432025-03-03T05:34:40ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01165e025111610.1371/journal.pone.0251116Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea.Won Mo JangJuyeon LeeSang Jun EunJun YimYoon KimMi Young KwakIncrease in travel time, beyond a critical point, to emergency care may lead to a residential disparity in the outcome of patients with acute conditions. However, few studies have evaluated the evidence of travel time benchmarks in view of the association between travel time and outcome. Thus, this study aimed to establish the optimal hospital access time (OHAT) for emergency care in South Korea. We used nationwide healthcare claims data collected by the National Health Insurance System database of South Korea. Claims data of 445,548 patients who had visited emergency centers between January 1, 2006 and December 31, 2014 were analyzed. Travel time, by vehicle from the residence of the patient, to the emergency center was calculated. Thirteen emergency care-sensitive conditions (ECSCs) were selected by a multidisciplinary expert panel. The 30-day mortality after discharge was set as the outcome measure of emergency care. A change-point analysis was performed to identify the threshold where the mortality of ECSCs changed significantly. The differences in risk-adjusted mortality between patients living outside of OHAT and those living inside OHAT were evaluated. Five ECSCs showed a significant threshold where the mortality changed according to their OHAT. These were intracranial injury, acute myocardial infarction, other acute ischemic heart disease, fracture of the femur, and sepsis. The calculated OHAT were 71-80 min, 31-40 min, 70-80 min, 41-50 min, and 61-70 min, respectively. Those who lived outside the OHAT had higher risks of death, even after adjustment (adjusted OR: 1.04-7.21; 95% CI: 1.03-26.34). In conclusion, the OHAT for emergency care with no significant increase in mortality is in the 31-80 min range. Optimal travel time to hospital should be established by optimal time for outcomes, and not by geographic time, to resolve the disparities in geographical accessibility to emergency care.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0251116&type=printable |
| spellingShingle | Won Mo Jang Juyeon Lee Sang Jun Eun Jun Yim Yoon Kim Mi Young Kwak Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea. PLoS ONE |
| title | Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea. |
| title_full | Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea. |
| title_fullStr | Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea. |
| title_full_unstemmed | Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea. |
| title_short | Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea. |
| title_sort | travel time to emergency care not by geographic time but by optimal time a nationwide cross sectional study for establishing optimal hospital access time to emergency medical care in south korea |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0251116&type=printable |
| work_keys_str_mv | AT wonmojang traveltimetoemergencycarenotbygeographictimebutbyoptimaltimeanationwidecrosssectionalstudyforestablishingoptimalhospitalaccesstimetoemergencymedicalcareinsouthkorea AT juyeonlee traveltimetoemergencycarenotbygeographictimebutbyoptimaltimeanationwidecrosssectionalstudyforestablishingoptimalhospitalaccesstimetoemergencymedicalcareinsouthkorea AT sangjuneun traveltimetoemergencycarenotbygeographictimebutbyoptimaltimeanationwidecrosssectionalstudyforestablishingoptimalhospitalaccesstimetoemergencymedicalcareinsouthkorea AT junyim traveltimetoemergencycarenotbygeographictimebutbyoptimaltimeanationwidecrosssectionalstudyforestablishingoptimalhospitalaccesstimetoemergencymedicalcareinsouthkorea AT yoonkim traveltimetoemergencycarenotbygeographictimebutbyoptimaltimeanationwidecrosssectionalstudyforestablishingoptimalhospitalaccesstimetoemergencymedicalcareinsouthkorea AT miyoungkwak traveltimetoemergencycarenotbygeographictimebutbyoptimaltimeanationwidecrosssectionalstudyforestablishingoptimalhospitalaccesstimetoemergencymedicalcareinsouthkorea |