JMIR Publications

ABSTRACT

Background:

Taiwan's implementation of the Categorization of Hospital Emergency Capability (CHEC) policy in 2009 aimed to enhance the quality of emergent care for Critical Time-Sensitive Diseases (CTSD), using time-based quality monitoring indicators.

Objective:

To investigate the effects of the CHEC policy on CTSDs and explore its possible unintended consequences.

Methods:

Using data from Taiwan's 2005 Longitudinal Health Insurance Database, this nationwide observational study examines the impact of the CHEC policy, implemented in 2009, on acute conditions and intensive care. We focused on acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. While AIS and STEMI had established guidelines and time-based quality surveillance under CHEC policy, septic shock and major trauma did not. Given that guidelines for major trauma were still in development, it served as the reference group. Adherence to diagnostic and treatment guidelines was our process quality measure, whereas medical utilization, rates of upward transfer, and mortality were outcome indicators. We evaluated the impact of the CHEC intervention on each outcome, including overall, within individual diseases, and analysis of between-disease differences in change from baseline to capture group-by-disease interaction effects by difference-in-differences estimation.

Results:

In our cohort of 9,923 cases, refined through 1:1 propensity score matching, 56% were male, mostly older adults. The CHEC policy significantly reduced medical orders and major diagnostic indicators, yet diagnostic fees notably increased. This led to a decrease in mortality rates, ultimately lowering overall medical expenses. Septic shock cases showed marked reductions in both primary diagnosis indicators and medical orders. In contrast, primary treatment indicators for AIS and STEMI rose, supporting the hypothesis of a health policy spotlight effect.

Conclusions:

This study highlights the CHEC policy's dual effects on reducing costs and enhancing patient outcomes. We observed a health policy spotlight effect, which led to a disproportionate improvement in guideline adherence and process quality for CTSDs that have time-based surveillance indicators.