Factors Affecting Treatment with Life-Saving Interventions, Computed Tomography Scans and Specialist Consultations

Chu-Chieh Chen; Chin-Yi Chen; Ming-Chung Ko; Yi-Chun Chien; Emily Chia-Yu Su; Yi-Tui Chen

doi:10.3390/ijerph17082914

Factors Affecting Treatment with Life-Saving Interventions, Computed Tomography Scans and Specialist Consultations

Int J Environ Res Public Health. 2020 Apr 23;17(8):2914. doi: 10.3390/ijerph17082914.

Authors

Chu-Chieh Chen¹, Chin-Yi Chen², Ming-Chung Ko^{1

3

4}, Yi-Chun Chien⁵, Emily Chia-Yu Su^{6

7}, Yi-Tui Chen¹

Affiliations

¹ Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City 108, Taiwan.
² Auditing and Advising Division, Trust Association of Republic of China, Taipei City 106, Taiwan.
³ Department of Urology, Taipei City Hospital, Taipei City 103, Taiwan.
⁴ School of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan.
⁵ Department of Otorhinolaryngology, China Medical University Hospital, Taichung City 404, Taiwan.
⁶ Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City 110, Taiwan.
⁷ Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei City 110, Taiwan.

Abstract

Background: Emergency treatments determined by emergency physicians may affect mortality and patient satisfaction. This paper attempts to examine the impact of patient characteristics, health status, the accredited level of hospitals, and triaged levels on the following emergency treatments: immediate life-saving interventions (LSIs), computed tomography (CT) scans, and specialist consultations (SCs). Methods: A multivariate logistic regression model was employed to analyze the impact of patient characteristics, including sex, age, income and the urbanization degree of the patient's residence; patient health status, including records of hospitalization and the number of instances of ambulatory care in the previous year; the Charlson Comorbidity Index (CCI) score; the accredited level of hospitals; and the triaged level of emergency treatments. Results: All the patient characteristics were found to impact receiving LSI, CT and SC, except for income. Furthermore, a better health status was associated with a decreased probability of receiving LSI, CT and SC, but the number of instances of ambulatory care was not found to have a significant impact on receiving CT or SC. This study also found no evidence to support impact of CCI on SC. Hospitals with higher accredited levels were associated with a greater chance of patients receiving emergency treatments of LSI, CT and SC. A higher assigned severity (lower triaged level) led to an increased probability of receiving CT and SC. In terms of LSI, patients assigned to level 4 were found to have a lower chance of treatment than those assigned to level 5. Conclusions: This study found that several patient characteristics, patient health status, the accredited level of medical institutions and the triaged level, were associated with a higher likelihood of receiving emergency treatments. This study suggests that the inequality of medical resources among medical institutions with different accredited levels may yield a crowding-out effect.

Keywords: computed tomography scans; immediate; life-saving intervention; specialist consultation; triage and acuity scale.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Child
Child, Preschool
Crowding
Emergency Service, Hospital* / standards
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Quality of Health Care
Referral and Consultation*
Tomography, X-Ray Computed*
Triage*
Young Adult