Policy Spotlight Effect in Critical Time-Sensitive Diseases: Evidence from Taiwan

Abstract

Background: Categorization of hospital emergency capability (CHEC) is a policy implemented worldwide to regionalize and guide the dispatch of critical emergent patients to the nearest appropriate hospital. We aimed to explore the CHEC policy spotlight effect on critical time-sensitive diseases with and without the influence of time-based surveillance indicators and guidelines. Methods: We conducted a nationwide retrospective cohort study between 2005–2011. Regarding critical time-sensitive diseases, our study targeted acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. Septic shock, AIS, and STEMI had specific guidelines while those for major trauma were under development. AIS and STEMI had time-based quality surveillance indicators under CHEC policy while major trauma and septic shock did not. Thus, both conditions were selected as external control for the policy spotlight effect. We selected diagnosis and treatment guideline adherence as process quality measures and defined medical utilization, upward transfer rate, and short-term mortality rate as outcome indicators. Findings: During this 6-year study, we observed 12,474, 3,622, 23,171, and 4,096 visits for AIS, STEMI, septic shock, and major trauma, respectively. AIS and STEMI cohorts had significantly higher rates of guideline adherence and better process quality than those of septic shock and major trauma cohorts. Furthermore, AIS and STEMI cohorts had a significant increase in diagnosis costs. Interpretation: The CHEC policy spotlight effect exists in critical time-sensitive diseases with time-based quality indicators. Importantly, disease entities without these indicators may experience decreases in diagnosis and treatment guideline adherence, indirectly jeopardizing their outcomes. Funding Information: None. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The study design was approved by the appropriate Institutional Review Board on 5 May 2018. The requirement for informed consent was waived due to the utilization of anonymized patient data.