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SDOH: Emergency department openings and closures have an impact on heart attack patients

Hospital closures represent a not-often reported social determinant of health, as they stress patient resources.

Jeff Lagasse, Associate Editor

Hospital emergency room closures can adversely affect health outcomes for heart attack patients at neighboring hospitals that are near or at full capacity. Conversely, when a new emergency department opens, health outcomes for patients at those so-called "bystander" hospitals improve.

That's according to a new study that looked specifically at outcomes for heart attack patients that is believed to be the first to evaluate the impact of emergency department openings and closures on bystander emergency departments. Researchers said the findings have implications for all patients, particularly in communities where inadequate health resources contribute to disproportionately poor health outcomes.

Lack of resources is considered a social determinant of health, as it's a socioeconomic factor that can have an impact on patients' health.

The study, funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, was released in the September issue of Health Affairs.


The results show that a hospital closure can impact care quality at a neighboring hospital by placing stress on the healthcare infrastructure, particularly if the latter is already tending to a socially and medically complex patient population.

Scientists used Medicare data between 2001 to 2013 to examine treatment and health outcomes for more than 1 million patients across 3,720 hospitals -- including in rural areas -- that had been affected by the closure or opening of an emergency department. The authors said they focused on heart attacks because of the known benefits of timely treatment.

The primary measures of health outcomes were 30-day, 90-day, and one-year mortality rates, as well as 30-day readmission rates. Researchers also examined if a patient received an angioplasty and/or stent to open a narrowed or blocked blood vessel that supplies blood to the heart -- procedures that can be affected by delayed care or constrained hospital resources.

Researchers found that when the closure of an emergency department was particularly onerous -- that is, when it resulted in an increased travel time of 30 minutes or more to get to another hospital -- health outcomes for patients in the bystander hospitals were negative. The one-year mortality rate for patients in those hospitals increased by 8% and the 30-day readmission rate increased by 6%. The likelihood of the same patients receiving the cardiac procedure declined by 4%.

On the other hand, researchers found that when an emergency department opened and reduced that driving time by at least 30 minutes, the patients in the bystander hospitals experienced a reduction in one-year mortality by 5%. Researchers also found that the likelihood of these patients receiving the cardiac procedure improved by 12%.


A December 2018 Waystar survey revealed that 68 percent of Americans identified having challenges in at least one SDOH risk category.

Of all patients in the "high risk" segment, 60 percent have never discussed their issues with a provider or their insurance company.

SDOH categories include financial or food insecurity, social isolation, housing insecurity, addiction, transportation access and health literacy. Consistent across payer classes (government-funded versus commercial insurance), the most commonly reported SDOH issues were financial insecurity and social isolation.

Twitter: @JELagasse

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