Reducing High-Users' Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study (original) (raw)
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This study analyzes one component of the health care safety net to determine whether or not being enrolled in a free or low-cost primary care physician access program subsequently affects emergency department utilization by uninsured adults ages 18 through 64. The study is a quantitative analysis of more than 40,000 individual patient records. An Intensity of Use Indicator (IUI) was developed for tracking individual and group ED utilization trends. the IUI should prove useful to hospital and other not-for-profit organizations concerned with tracking cost effectiveness of programs for uninsured adults.
Likelihood of recurrent high Emergency Department utilization by Indigent Patients
Recurrent utilization of emergency medical services by certain patient populations is a challenge at the University of New Mexico Emergency Department (UNM ED) and at other institutions. Data suggest that a significant percentage of patients treated in the UNM ED could be treated in other, less costly outpatient settings. Existing data were used to analyze trends in UNM ED utilization among four distinct populations – managed uninsured patients (UNM Care), unmanaged uninsured patients (Self-pay), managed Medicaid patients (Salud), and unmanaged Medicaid patients (Medicaid). We hypothesized that those who previously had high usage of the Emergency Department (ED) in the index year would continue high use of the ED in the next year. In addition, we hypothesized that patients in managed programs, UNM Care and Salud, would likely have a lower recurrent use of the ED than patients in unmanaged programs, Self-pay and Medicaid, patients. Our data included 19,461 adult patients, with 1,104 ...
Frequent users of US emergency departments: characteristics and opportunities for intervention
Emergency Medicine Journal, 2014
Objective To compare the characteristics of US adults by frequency of emergency department (ED) utilisation, specifically the prevalence of chronic diseases and outpatient primary care and mental health utilisation. Methods We analysed 157 818 adult participants of the 2004-2009 US National Health Interview Survey, an annual nationally representative sample. We defined ED utilisation during the past 12 months as non-users (0 ED visits), infrequent users (1-3 visits), frequent users (4-9 visits) and super-frequent users (≥10 visits). We compared demographic data, socioeconomic status, chronic diseases and access to care between these ED utilisation groups using multivariable logistic regression. Results Overall, super-frequent use was reported by 0.4% of US adults, frequent use by 2% and infrequent ED use by 19%. Patients reporting ≥4 ED visits were more likely to have Medicaid insurance (OR 1.57; 95% CI 1.34 to 1.85 vs private); fair or poor self-reported health (OR 2.98; 95% CI 2.57 to 3.46 vs excellent-very good); and chronic diseases such as coronary artery disease (OR 1.61; 95% CI 1.40 to 1.86), stroke (OR 1.58; 95% CI 1.36 to 1.83) or asthma (OR 1.64; 95% CI 1.46 to 1.85). While patients reporting the ED as their usual source of sick care were more likely to have ≥4 ED visits (OR 7.09; 95% CI 5.61 to 8.95 vs outpatient clinic as source), ≥10 outpatient visits in the past 12 months was also associated with frequent ED use (OR 11.4; 95% CI 9.09 to 14.2 vs no outpatient visits). Conclusions Frequent ED users had a large burden of chronic diseases that also required high outpatient resources. Interventions designed to divert frequent ED users should focus on chronic disease management and access to outpatient services, particularly for Medicaid beneficiaries and other high risk subpopulations.
Care Intervention and Reduction of Emergency Department Utilization in Medicaid Populations
2019
Care Intervention and Reduction of Emergency Department Utilization in Medicaid Populations by Eno J. Rouse Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University February 2019 Abstract Expansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences in utilization patterns that exist among the Medicaid population that participated in an optimal level ofExpansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences i...
Health services research and managerial epidemiology, 2016
The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Pat...
2005
The purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease “inappropriate” or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six emergency departments and six federally qualified health centers were evaluated. Secondary data over a three-year time period were abstracted from patient and organizational records at the hospitals and federally qualified health centers. The utilization data from the emergency departments and health centers were compared. The analysis revealed a significant change in the number of non-urgent visits by self-pay patients at the emergency departments when the health centers expanded. A 32.2 percen...
Emergency Medical Care: Types, Trends, and Factors Related to Nonurgent Visits
Academic Emergency Medicine, 1999
Objectives: To describe and compare national trends in ED use by statistical analyses on data from the 1992 to 1996 National Hospital Ambulatory Medical Care Survey (NHAMCS) with a special interest in factors related to nonurgent visits. Methods: The NHAMCS collects data for ED visits using a four-stage national probability sample. Data from 135,723 ED visits in 1992-1996 were analyzed using the chi-square test for proportions with logistic regression modeling for multivariate analysis. Results: More than half of the ED visits were considered nonurgent. There was a decreasing trend for nonurgent ED visits over the first three years of the sample (54.0% to 52.1%, p < 0.05). The proportion of ED visits for nonurgent care bounced back in 1995 (54.7%) and 1996 (54.1%). Significant variation existed in the proportion of nonurgent care visit based on disease category, age, race, and insurance coverage status. Marked variation in nonurgent visits also existed among geographic regions and types of hospital ownership. Conclusions: Analyses of data from the NHAMCS identify trends in ED use. The study of nonurgent ED visits with this database has inherent methodologic problems such as retrospective coding and geographic coding inconsistency. Since the nonurgent visit is clearly linked to certain social-demographic factors, addressing these underlying issues by establishing a comprehensive health care system is a priority.
Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change (HSC). About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people. Nonetheless, there are clearly opportunities to develop less-costly care options than emergency departments for both nonelderly Medicaid and privately insured patients. To reduce ED use, policy makers might consider how to encourage development of care settings that can quickly handle a high volume of potentially urgent medical problems. Policy makers may want to focus initially on conditions that account for high ED volume that could likely be treated in less resource-intensive settings. For exampl...
Patients seek care in the emergency department (ED) for many reasons, including non-urgent conditions that could be treated in a primary care physician’s (PCP) office or alternative health facility. Convenience, need-blindness, and resourcefulness draw patients towards the ED, and lead to ED overuse. In this article, we outline a comprehensive and integrated approach that includes specific solutions and quality improvements to overcome the excessive use of EDs for non-urgent conditions. We target three critical components of the healthcare system: 1) hospitals and other physician groups, 2) insurance companies, and 3) patients. Our recommendations include expanding access to primary care, offering financial incentives for both patients and physicians to reduce unnecessary ED visits, and fostering patient awareness of alternative health care options through community health workers (CHWs) and mobile worksite programs.