Background Under the Transformation Programme (2006) of the Health Service Executive (HSE), emergency and urgent care in Ireland is moving towards a ‘systems-based’ approach for discrete geographical regions.
The SIREN (Study of the Impact of Reconfiguration on Emergency and Urgent Care Networks) project aims to describe and evaluate the performance of the different emergency and urgent care systems (EUCS) in Ireland.
Methods Directly age and case mix -standardised case fatality ratios (CFRs) and directly age and gender standardised population mortality rates (PMRs) were constructed at a regional level for a series of emergency conditions.
The regional rates were weighted by the 2012 national standard population to yield the adjusted rates. For the PMRs, the standard population was based on the national population by age group and gender. When constructing the CFRs, the standard population was based on the annual number of emergency condition events (deaths and admissions) seen nationally by age group and condition.
Using a Poisson model, we predicted the change to CFRs associated with a 10% increase in boundary crossing i.e. the proportion of emergency patients travelling to another county to attend a hospital.
Results PMRs for the selected emergency conditions fell over the period. The national PMR almost halved from the observed 2002 level of 22 per 10,000 to 12 per 10,000 by 2012.
Admissions for total conditions fell by 17% nationally but to 1,596 per 10,000 between 2002 and 2012.
Consistent regional variation, over time and condition, has been identified in both PMRs and CFRs.
Many of the highest results were observed in the West and South-West of the country, areas with high levels of geographical remoteness.
While all counties experienced significant decreases in PMRs, the rate of decline observed in CFRs varied, with some counties not registering significant changes over the 10 years.
Four counties experienced an absolute change in boundary crossing of 10% or more in successive years. Initial analysis did not find evidence of an association between boundary crossing and changes in case fatality ratios.
Conclusion Despite a fall in PMRs and CFRs, both nationally and across regions, a distinct pattern between the predominantly urban East and rural areas in the West and the South exist. Initial analysis suggests changes in the movement of patients between regions did not significantly change county CFRs. Further research will explore these findings.
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