Abstract
Objective
To determine whether ambulance arrival to the emergency department has remained an
unidentified signal of perceived medical acuity. Informed by economic signaling theory,
does arrival via ambulance affect resource utilization given varying levels of patient
acuity?
Methods
The analysis examined a nationally representative sample of de-identified emergency
department patient encounters from 2011 to 2015, gathered from the National Hospital
Ambulatory Medical Care Survey (NHAMCS). Multivariate logistic regression analysis
was employed using regional and time-fixed effects. The provision of twenty diagnostic
and imaging services was analyzed. Patient encounters were also categorized into five
acuity-levels.
Results
Drawing from the NHAMCS dataset, 98,888 emergency department records were analyzed,
weighted to represent 504.5 million estimated emergency department patient encounters.
Findings suggest that patients transported to the hospital via ambulance are more
likely than those who arrive by other means to receive 19 of the 20 analyzed diagnostic
testing and imaging services. Furthermore, when analyzed by acuity-level, the disparity
of service provision is the greatest among low-acuity patients, where medical complaints
are argued to be the most subjective.
Conclusions
The results are consistent with the notion that emergency department medical providers
readily accept ambulance transport as a valid signal of patient acuity, regardless
of true acuity level. Consequently, patients transported to the hospital via ambulance
may be receiving a disproportionate amount of medical resources in an increasingly
cost-conscious environment.
Keywords
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Article Info
Publication History
Published online: August 29, 2018
Accepted:
August 27,
2018
Received in revised form:
August 26,
2018
Received:
April 10,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
