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Preferences for centralised emergency medical services: Discrete choice experiment

Lookup NU author(s): Dr Nawaraj Bhattarai, Dr Peter McMeekin, Professor Christopher Price, Professor Luke Vale

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objectives It is desirable that public preferences are established and incorporated in emergency healthcare reforms. The aim of this study was to investigate preferences for local versus centralised provision of all emergency medical services (EMS) and explore what individuals think are important considerations for EMS delivery. Design A discrete choice experiment was conducted. The attributes used in the choice scenarios were: travel time to the hospital, waiting time to be seen, length of stay in the hospital, risks of dying, readmission and opportunity for outpatient care after emergency treatment at a local hospital. Setting North East England. Participants Participants were a randomly sampled general population, aged 16 years or above recruited from Healthwatch Northumberland network database of lay members and from clinical contact with Northumbria Healthcare National Health Service Foundation Trust via Patient Experience Team. Primary and secondary outcome measures Analysis used logistic regression modelling techniques to determine the preference of each attribute. Marginal rates of substitution between attributes were estimated to understand the trade-offs individuals were willing to make. Results Responses were obtained from 148 people (62 completed a web and 86 a postal version). Respondents preferred shorter travel time to hospital, shorter waiting time, fewer number of days in hospital, low risk of death, low risk of readmission and outpatient follow-up care in their local hospital. However, individuals were willing to trade off increased travel time and waiting time for high-quality centralised care. Individuals were willing to travel 9 min more for a 1-day reduction in length of stay in the hospital, 38 min for a 1% reduction in risk of death and 112 min for having outpatient follow-up care at their local hospital. Conclusions People value centralised EMS if it provides higher quality care and are willing to travel further and wait longer.


Publication metadata

Author(s): Bhattarai N, McMeekin P, Price CI, Vale L

Publication type: Article

Publication status: Published

Journal: BMJ Open

Year: 2019

Volume: 9

Issue: 11

Online publication date: 05/11/2019

Acceptance date: 21/10/2019

Date deposited: 18/11/2019

ISSN (electronic): 2044-6055

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/bmjopen-2019-030966

DOI: 10.1136/bmjopen-2019-030966

PubMed id: 31694847


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