Journal Article

Case fatality ratios for serious emergency conditions in the Republic of Ireland: a longitudinal investigation of trends over the period 2002–2014 using joinpoint analysis

Browne, John, Healy, Orla, Lynch, Brenda, Fitzgerald, Anthony P., Buckley, Claire, Foley, Conor, Corcoran, Paul

2018

Overview

Background In the past decade, the Republic of Ireland has undertaken significant reconfiguration programmes to improve emergency services. During this time the public healthcare system experienced a large real decrease in resources. This study assesses national and regional population outcomes over the period 2002–2014, and whether changes coincide with system reconfiguration and the financial restrictions imposed by the 2008 recession. Methods Case fatality ratios (CFRs) were constructed for emergency conditions for 2002–2014. Total emergency conditions and individual condition trends were analysed nationally using joinpoint analysis. National results informed the investigation of trends at a regional and county level using an inverse standard error weighted generalised linear model with a log link to construct funnel plots. County-level CFRs were compared for the first and last 3 years of the period to further investigate the changes to county results over the 13 year period, specifically in comparison to the national-level CFR. Results Nationally, there was an annual fall in CFRs (2.1%). The decline was faster from 2002 to 2007 (annual percentage change = − 3.4; 95% CI-4.4, − 2.4), compared to 2007–2014 (annual percentage change = − 1.2; 95% CI -1.9, − 0.5). The South-East had a lower rate of decrease and the West had a higher rate. Cross sectional analysis of two periods (2002–2004 and 2012–2014) showed high consistency in the counties performance relative to the national CFR in both periods. Conclusion Change in the national trend coincided with the onset of economic stress on the public health system. Attributing the decline in CFR improvement to economic factors is weakened by the uneven nature of the trend change. No distinct pattern of change was identified among regions which underwent substantial reconfiguration of emergency services.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age groups / Analysis / Critical Care / Cross-Sectional Studies / Economic aspects / Economic Recession / Emergency care / Emergency medical care / Emergency Medical Services - standards / Emergency Medical Services - supply & distribution / Fatalities / Female / Health Administration / Health Informatics / Health services / Health systems / Heart attacks / Heart failure / Hospitals / Humans / Ireland / Ireland - epidemiology / Ischemia / Linear Models / Longitudinal Studies / Male / Medical care / Medicine / Medicine & Public Health / Mortality / Mortality - trends / Nursing Research / Patients / Planning / Public Health / Quality / Reconfiguration / Regional variations / Regions / Research Article / Rural areas / safety and outcomes / Severity of Illness Index / Statistical software / Stroke / Trauma / Trends / Wellness programs