Utilization of Outpatient Emergency Care in Westphalia-Lippe: A Health Geographic Analysis

Abstract

Identification of geographical variations in the utilization of outpatient emergency care facilities is the most effective tool to locate regions with the greatest potential for increasing quality and efficiency in emergency care. The aim of the study was to estimate utilization of emergency care facilities in a regression model, taking into account local dependencies and agglomeration effects. The basis of this ecological study was formed by all outpatient emergency patient contacts in 2013 (n=1,927,471), which were aggregated according to the place of residence to the 231 municipalities of the supply area of the Association of Statutory Health Insurance Physicians Westphalia-Lippe. With the help of geostatistical procedures, the proportion of outpatient emergency patient contacts in hospital ambulances was modeled by socio-economic, patient-focused and geographic variables. The use of hospital ambulances (Ø=56.2%) in Westphalia-Lippe is heterogeneous (min=14.8%, max=83.9%). The patient autonomy and state of health, the spatial distance to emergency care facilities and the Ruhr region were identified as important influencing factors. In this study, the cross-border perspective plays an important role in the outpatient use of emergency care facilities and helps to identify potential intervention areas.