What characteristics of patients and local health systems are associated with ED utilization?
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Transcript of What characteristics of patients and local health systems are associated with ED utilization?
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What characteristics of patients and local health systems are
associated with ED utilization?
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ED Utilization rates are high among:
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High use population groups
• Infants• Age 75 and above• Nursing home residents• Homeless• African Americans• Individuals covered by insurance
(Medicaid/SCHIP)
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Annual ED visits by high-use population groups, 2006.
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Nursing home residents
• Annual ED visits by high use population groups, 2006
• 140 ED visits per 100 individuals• 2% group’s share of all ED visits
• Medicaid/SCHIP enrollee 26% share
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ED patients who are not admitted to the hospital and frequent ED users account for large shares of
total ED volume
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• 15% admission/ transfer• Not admitted, multiple ED visits
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Non-citizen residents of the US use ED at a much lower rate than the
national average. African Americans have higher rates.
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• Non-citizen residents have lower ED utilization rate than the national average (17.2 less per 100 population)
• African American residents use the ED more frequently then white (by 9.9 visits per 100 population)
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Without controlling for other factors, the rate of ED use is higher for uninsured patients relative to
the privately insured.
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The rate of ED use is higher for patients covered by insurance
relative to the uninsured patients.
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Uninsured patients use the ED at the same rate as the privately
insured (after adjustment).
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Expected payer distribution of total ED visits, 2006
• Private insurance 40%
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The recent growth in volume of ED utilization is driven by individuals
with private insurance, higher income and private physicians as
their usual source of care.
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• The share of visits attributable to patients with income above 400% of the poverty level increased from 21.9 to 29.0%
• Shares for other income groups fell or fluctuated with no pattern.
• Rising use of ambulatory care (from 52.4 to 59.0%)
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Low income and poor health are strong predictors of ED utilization
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Poorer health of Medicaid patients vs uninsured patients
• Self reported health status• Presence of chronic illness• Difficulty with activities of daily living
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Frequent ED users have substantially physical and mental health problems and typically low
income
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• ED as a supplement rather than a substitute for other forms of care
• Higher than average utilization of other health services
• Have a usual source of acre outside the ED
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Patients with “extreme” levels of ED use have a variety of complex
physical and mental health problems
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The supply and capacity of providers to meet the demand for
ambulatory care also influences the rate of ED use within communities.
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High ED Utilization rate in communities
• Limited primary care providers• Greater supply of ED capacity
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How frequently do patients use the ED for non-urgent or preventable
conditions?
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Use of the ED for non-urgent and preventable conditions appears to be very common and growing. But identification of these conditions
remains imprecise.
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• All of the increase in total ED visits between 1997-1998 and 1999-2000 attribute to visits classified as semi-urgent, non-urgent or no/unknown triage. (National Center for Health Statistics and Cunningham)
• 56% of ED visits were classified as ambulatory care sensitive from 1997-2000 (Weinick et al.)
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Use of the ED for ambulatory care sensitive conditions is associated with limited access, financial or
otherwise to, primary care providers.
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• Utilization is high among: Medicaid patients and uninsured/self-pay.
• Those with a regular doctor were significantly lees likely to have a non-urgent ED visit. (5 EDs at NE US)
• Simply having access to clinic care does not reduce non-urgent ED use. (St. Louis clinic)
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Children age 5 and under are very likely to use the ED for non-urgent
conditions.
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What are the factors that influences this utilization?
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Preference for ED care (focus group)
• Convenience• Access to specialty care• Availablity of higher quality care• Service to all kinds of patients
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More patient perceptions
• Professional reassurance• Verification of non-urgency• Parental responsibility