Modeling the Association between 2009 H1N1 influenza pandemic and Emergency Department operations in United States using National Hospital Ambulatory Medical Care Survey (NHAMCS) Open Access
Patil, Dattatraya (2013)
Abstract
Introduction: Hospital emergency departments (ED) plays a crucial role in US society, both providing care to acutely ill and injured patients and serving as a major point of entry into US healthcare system for uninsured patients. In response to emergent health care situations like Influenza pandemic 2009, ED is primary source of contact for majority of population. Measurement of ED performance during these times is important for future development of better equipped and prepared health care system.
Methods: To estimate the effect of Influenza -09, NHAMCS national sampling survey was combined from year 2007 to 2010. ED-length of visit and ED-boarding time were primary outcome measures. The exposure Influenza Activity Period' was stratified in three levels No/Seasonal/Pandemic Influenza Activity based on CDC guidelines of WHO/NREVSS lab survey. Important covariates were classified in domains of demographic, ED/visit characteristics and hospital attributes.
Results: Pandemic Influenza period significantly (5.47% excess time, p-value 0.0038) affected ED operations when compared with No Influenza period. During pandemic times, African-Americans (12.30% more time) and Hispanics (9.11% excess time) were most affected. Ordering of any diagnostic/screening test in ED (54.85% more time) or advanced imaging techniques (26.85% more time) lead to possible ED resources utilization on acutely ill (11.66% more time) patients. Location of hospital in urban area (10.67% more time) and visit to a teaching institution (20.5% excess time) increased the overall ED-LOV. We found no significant association between ED-BTI and pandemic (p-value 0.26) or seasonal (p-value 0.32) Influenza period, but, ED-BTI was significantly associated with ED resources factors.
Conclusion: Pandemic Influenza significantly affected ED operations. Even though, seasonal Influenza followed similar trends the effects of pandemic Influenza were more pronounced. Although, there was no association of ED-BTI with Influenza activity periods, hospital infrastructure and resource factors showed positive impact signifying the fact that functional and infrastructural improvements could potentially induce positive effects on acute and long term care.
Table of Contents
Table of Contents
CHAPTER 1: LITERATURE REVIEW... 1
Background. 1
Database description. 3
Outcome variable. 5
Length of visit (ED-LOV). 5
Public Health Importance of ED-LOV.. 5
Boarding time (ED-BTI). 7
Public Health Importance of ED-BTI. 7
Exposure variable: 2009 H1N1 influenza pandemic. 9
Background. 9
Public health Importance of research on influenza: 10
Primary covariates of interest 11
1. Demographic factors: 11
2. Physician and Visit characteristics: 12
3. Hospital factors. 14
Research Question. 17
CHAPTER 2: MANUSCRIPT.. 19
Introduction. 19
Methods. 21
Results. 26
Discussion. 30
CHAPTER 3: PUBLIC HEALTH IMPLICATIONS: 34
Tables. 38
Figure 1. 47
Appendix 1: Literature Review Table . 48
IRB Exemption Letter
REFERENCES: 50
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