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

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Resource type
Journal Article
Authors/contributors
Title
Impact of integrated health system changes, accelerated due to an earthquake, on emergency department attendances and acute admissions: a Bayesian change-point analysis
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.
Publication
BMJ open
Volume
6
Issue
5
Pages
e010709
Date
05 11, 2016
Journal Abbr
BMJ Open
Language
en
DOI
10.1136/bmjopen-2015-010709
ISSN
2044-6055
Short Title
Impact of integrated health system changes, accelerated due to an earthquake, on emergency department attendances and acute admissions
URL
https://doi.org/10.1136/bmjopen-2015-010709
Library Catalog
PubMed
Rights
http://creativecommons.org/licenses/by-nc/4.0/
Extra
PMID: 27169741 PMCID: PMC4874100
Link
Notes

Study topic: Evaluation of the impact of Canterbury’s integrated health system transformation—accelerated by the 2011 Christchurch earthquake—on emergency department (ED) attendances and acute hospital admissions.

Study type: Interrupted time series analysis using Bayesian change-point modelling

Key findings:

  • The 2010–2011 Canterbury earthquakes catalysed large-scale health system integration, leading to sustained reductions in emergency department (ED) attendances and acute hospital admissions.
  • Between 2008 and 2014, ED attendances and acute admissions in Canterbury remained flat or declined, in contrast to national trends, which showed increases over time.
  • Reductions were especially notable in older age groups and for ambulatory sensitive conditions, suggesting improved management in primary and community care.
  • Innovations included the Acute Demand Management Service (ADMS), Electronic Request Management System (ERMS), and enhanced primary-secondary coordination via alliance-based governance.
  • Relevance to HealthPathways: HealthPathways was one of several innovations supporting integrated care by enabling shared clinical pathways and standardised management across care settings, contributing to reduced acute service utilisation.
  • The authors suggest that this coordinated, cross-sector approach can be a model for achieving population-level impact on hospital demand.
Citation
Schluter, P. J., Hamilton, G. J., Deely, J. M., & Ardagh, M. 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), e010709. https://doi.org/10.1136/bmjopen-2015-010709
Topic
Link to this record
https://researchbibliography.healthpathwayscommunity.org/bibliography/TNH85CZ6