Governmental designation of emergency medical institutes: 30 days mortality by types of designation

Abstract

Background: In 2000, the South Korean government introduced a program in emergency medical institutions throughout the country to establish effective management system for emergency patients. The aim of this study was is to investigate the effectiveness of this program for emergency patients and establish evidence for more effective strategy by comparing the relationship between types of emergency medical center and 30 day mortality after hospitalization in inpatients with cerebrovascular and cardiovascular diseases. Methods: We used National Health Insurance claim data (n = 111,741) from 115 hospitals during 2010-2013 to analyze readmissions within 30 days after hospitalization due to cerebrovascular and cardiovascular diseases. We performed x2 tests, analysis of variance and logistic regression analysis using generalized estimating equation (GEE) modeling to investigate associations with 30 day mortality after hospitalization. Results: Deaths within 30 days of hospitalization due to cerebrovascular and cardiovascular diseases were 6.5%. Regional emergency medical center and localized emergency medical center had lower risk in 30 days mortality after hospitalization than localized emergency medical agency (regional emergency medical center = OR: 0.71, 95 CI: 0.60-0.84; localized emergency medical center = OR: 0.81, 95% CI: 0.72-0.90; ref. = localized emergency medical agency). In addition, reduction in 30 days mortality by types of emergency medical institutes was more highly associated in cerebrovascular diseases than cardiovascular diseases. Conclusions: Government designated higher level emergency medical institutes had better outcomes in emergency medical care than localized emergency medical agencies. Thus, health policy makers have to consider optimal reimbursement in the field of emergency medicine.