Association between ambulance diversion of the nearest ED and access, treatment and outcomes, based on model 1
| Base rate (among patients in reference group) | Access (admitting hospital has) | Treatment | Outcomes | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Cardiac care unit | Catheterisation laboratory | CABG | Catheterisation/PCI | Thrombolytic therapy | CABG | 30-day mortality | 90-day mortality | 1-year mortality | 30-day readmission | |
| (60%) | (73%) | (65%) | (51%) | (1%) | (6%) | (16%) | (22%) | (29%) | (34%) | |
| Diversion status (reference group: nearest ED not on diversion on the day of admission) | ||||||||||
| Nearest ED’s exposure to diversion on the day of admission | ||||||||||
| <6 h | −1.40* | −1.70** | −0.94 | −0.86 | 0.18 | −0.42 | −0.24 | 0.11 | −0.20 | −0.02 |
| (−2.74, −0.05) | (−2.91, −0.49) | (−2.11, 0.23) | (−2.23, 0.51) | (−0.23, 0.59) | (−1.17, 0.34) | (−1.31, 0.83) | (−1.15, 1.36) | (−1.66, 1.25) | (−1.86, 1.82) | |
| (6–12) hours | −0.40 | −0.79 | −0.25 | −1.27 | −0.27 | −0.50 | 0.29 | 0.40 | 0.21 | 0.57 |
| (−2.03, 1.22) | (−2.41, 0.82) | (−1.83, 1.33) | (−2.91, 0.37) | (−0.72, 0.18) | (−1.42, 0.42) | (−1.04, 1.62) | (−1.08, 1.89) | (−1.43, 1.86) | (−1.48, 2.62) | |
| ≥12 h | −2.61* | −2.44** | −2.25* | −2.19* | −0.14 | −0.29 | 1.10 | 1.78* | 2.78** | 2.12 |
| (−4.81, −0.40) | (−4.24, −0.65) | (−4.02, −0.48) | (−4.19, −0.19) | (−0.72, 0.43) | (−1.29, 0.71) | (−0.60, 2.81) | (0.01, 3.55) | (0.76, 4.80) | (−0.55, 4.79) | |
| Interaction between black patients and diversion level | ||||||||||
| X low diversion | −0.76 | 2.51 | 3.79 | −2.16 | −1.11 | 0.12 | 0.20 | 2.71 | 5.56* | 2.35 |
| (<6 h) | (−5.62, 4.10) | (−2.15, 7.17) | (−1.18, 8.77) | (−7.85, 3.52) | (−2.51, 0.29) | (−2.48, 2.72) | (−4.16, 4.56) | (−1.71, 7.12) | (0.25, 10.86) | (−4.13, 8.83) |
| X medium diversion | −0.12 | 1.08 | 3.05 | −0.08 | −0.93 | 2.77 | 3.43 | 4.94 | 2.55 | 0.60 |
| (6–12) hours | (−5.73, 5.49) | (−4.81, 6.98) | (−2.89, 9.00) | (−7.13, 6.97) | (−2.25, 0.39) | (−0.40, 5.94) | (−2.28, 9.14) | (−0.65, 10.53) | (−3.16, 8.26) | (−7.81, 9.02) |
| X high diversion | 3.37 | −2.38 | 1.41 | 0.30 | −2.70** | −0.87 | 2.58 | 2.49 | 1.61 | −0.28 |
| (≥12 h) | (−2.88, 9.63) | (−8.82, 4.05) | (−4.54, 7.36) | (−6.24, 6.84) | (−4.20, −1.19) | (−4.32, 2.58) | (−3.33, 8.50) | (−4.29, 9.27) | (−5.83, 9.05) | (−11.01, 10.45) |
| Control for tech access | NA | NA | NA | No | No | No | No | No | No | No |
| Control for treatment | NA | NA | NA | NA | NA | NA | No | No | No | No |
| N | 29 939 | 29 939 | 29 939 | 29 939 | 29 939 | 29 939 | 29 939 | 29 939 | 29 939 | 23 199 |
Nearest ED based on Google query of driving distance.
When compared to the reference group, the regression-adjusted difference is statistically significant at *p<0.05, **p<0.01.
CABG, coronary artery bypass graft; ED, emergency department; PCI, percutaneous coronary intervention.