TY - JOUR T1 - Mortality before and after reconfiguration of the Danish hospital-based emergency healthcare system: a nationwide interrupted time series analysis JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 202 LP - 213 DO - 10.1136/bmjqs-2021-013881 VL - 32 IS - 4 AU - Marianne Flojstrup AU - Søren Bie Bie Bogh AU - Mickael Bech AU - Daniel Pilsgaard Henriksen AU - Søren Paaske Johnsen AU - Mikkel Brabrand Y1 - 2023/04/01 UR - http://qualitysafety.bmj.com/content/32/4/202.abstract N2 - Objectives The study aimed to investigate how the ‘natural experiment’ of reconfiguring the emergency healthcare system in Denmark affected in-hospital and 30-day mortality on a national level. The reconfiguration included the centralisation of hospitals and the establishment of emergency departments with specialists present around the clock.Design Hospital-based cohort study.Setting All public hospitals in Denmark.Participants Patients with an unplanned contact from 1 January 2007 until 31 December 2016.Interventions Stepped-wedge reconfiguration of the Danish emergency healthcare system.Main outcome measures We determined the adjusted ORs for in-hospital mortality and HRs for 30-day mortality using logistic and Cox regression analysis adjusted for sex, age, Charlson Comorbidity Index, income, education, mandatory referral and the changes in the out of hours system in the Capital Region. The main outcomes were stratified by the time of arrival. We performed subgroup analyses on selected diagnoses: myocardial infarction, stroke, pneumonia, aortic aneurysm, bowel perforation, hip fracture and major trauma.Results We included 11 367 655 unplanned hospital contacts. The adjusted OR for overall in-hospital mortality after reconfiguration of the emergency healthcare system was 0.998 (95% CI 0.968 to 1.010; p=0.285), and the adjusted OR for 30-day mortality was 1.004 (95% CI 1.000 to 1.008; p=0.045)). Subgroup analyses showed some possible benefits of the reconfiguration such as a reduction in-hospital and 30-day mortality for myocardial infarction, stroke, aortic aneurysm and major trauma.Conclusions The Danish emergency care reconfiguration programme was not associated with an improvement in overall in-hospital mortality trends and was associated with a slight slowing of prior improvements in 30-day mortality trends.Data may be obtained from a third party and are not publicly available. Data may be obtained from a third party and are not publicly available. According to Danish law, data cannot be shared. However, the data sources are available for other researchers pending approval from the Statistics Denmark. ER -