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Table 1 Characteristics of included studies

From: Effects of service changes affecting distance/time to access urgent and emergency care facilities on patient outcomes: a systematic review

Study IDCountryStudy designConditionInterventionSample sourceSample sizeLength of study
Avdic 2016 [6]Other Europe
Controlled observational
Analysis of linked administrative datasets
Acute MIHospital ED closureAdministrative registers obtained from the Swedish National Board of Health and Welfare (hospitalisations and deaths)Approximately 374,000 events21 years (1990–2010)
Combier 2013 [7]France
Burgundy region
Uncontrolled observational
Before–after study
Obstetric/neonatal complicationsObstetric unit closureHospital discharge summary data for all deliveries from 22 weeks’ gestation in the region’s maternity units111,001 deliveries10 years (2000–2009)
El Sayed 2012 [8]USAUncontrolled observational
Before–after study
General emergency careHospital ED mergerRoutinely collected EMS and ED data5338 EMS transports; 21,685 ED visits3 months (June 1 to August 262,010)
Hansen 2011 [9]Other Europe
Uncontrolled observational
Before–after study
General emergency careHospital ED closureDanish National Person Registry including all Danish residents21,000 residents of Viborg county (2300 from Morso)7 years (1997–2003)
Hsia 2012 [10]USA
Controlled observational
General emergency care
Acute MI, stroke, sepsis and asthma/COPD
Hospital ED closureCalifornia Office of State-wide Health and Planning Development database, combined with information on ED closures by year between 1999 and 2009785,385, of whom 67,577 (8.6%) experienced an increase in distance to ED care as a result of an ED closure11 years (1999 to 2009)
Hsia 2014 [11]USAOther cross-sectional comparison of existing datasets, compared at T1 and T2 10 years later.Major trauma
Acute trauma aged 20 or older.
Trauma unit closureDatabase of trauma centres open at T1 and 10 years later at T2. Patient discharge database. Household demographic database.266,023 had no increased drive time, 5122 had increased drive time.Compared 1999 to 2009
Knowles 2018 [3]UKControlled observational
Interrupted time series
General emergency careHospital ED closure or downgradeONS, HES, ambulance dispatch recordsUnable to locate, refers to areas onlyTwo years pre closure and 2 years post closure.
Mustonen 2017 [12]Other Europe
Finland (Vantaa, Finland’s third-largest city, with approximately 182,000 inhabitants)
Controlled observational
Controlled before–after study
General emergency carePrimary care ED closureElectronic health records plus monthly mortality statistics by age groupsUnclear (34,000 inhabitants in area with ED closure)4 years (February 2004 to December 2007)
Roberts 2014 [13]UK
England only
Uncontrolled observational
National data on distance travelled to emergency care plus three case studies of local reconfiguration
General emergency careHospital ED closure or relocationHospital Episode Statistics plus data on ED attendances from every major (type 1) ED in England13 million ED attendances and 5.4 million emergency admissions (2011/12)10 years (2001/2 to 2011/12)
Shen 2012 [14]USAControlled observational
Difference in difference approach
Acute MIHospital ED closure or relocationAmerican hospital annual survey, database for California hospitals, Medicare claimsUnclear4 years before change to 4 years after change to ED access
Shen 2016 [15]USAControlled observationalAcute MIHospital ED closure or relocationMedicare records, cost provider systems1.35 million patients90-day mortality reported in this paper
Yaghoubian 2008 [16]USA
California (Los Angeles County)
Uncontrolled observational
Interrupted time series
Major traumaTrauma centre closurePatient records from prospectively collected database (Trauma and Emergency Medicine Information System)14,9969 years 2 months (January 1997 to 1 March 2006)