PIH55 NATIONAL PATTERNS OF EMERGENCY DEPARTMENT USE FOR WOMEN WITH ENDOMETRIOSIS, 2006-2015

Abstract

To characterize national trends in emergency department (ED) visits, disposition and charges for endometriosis. ED visits for endometriosis by women aged 18–49 were extracted from the Health Care Utilization Project Nationwide Emergency Department Sample into three cohorts for calendar years 2006–2007, 2010–2011 and 2014–Q3 2015. Visits with a principal diagnosis code of endometriosis (International Classification of Disease, 9th Edition, code 617.x) were included. Visits with a diagnosis of malignant neoplasm of female genital organs were excluded. Patient and hospital characteristics were compared across cohorts using analysis of variance. Trends in the proportion of ED visits ending in inpatient admission or transfer to another hospital and in mean ED charges (2015 US dollars) were assessed using generalized linear models controlling for patient and hospital characteristics. Inpatient admission/transfer was chosen as an outcome representative of potentially preventable admissions. Nationally representative estimates were generated based on survey weights. The annual number of ED visits nationally was stable at approximately 15,000 visits per year during 2006–2015. Mean age was 30 years; 41% of visits were from the South Census region; and 8% had ≥1 Charlson comorbidity. From 2006–07 to 2014–15, the composition of ED visits shifted away from private pay (42.0% vs. 35.3%) and uninsured (23.6% vs. 16.6%) to Medicaid (26.7% vs. 40.1%) and became more concentrated in metro-teaching hospitals (33.9% vs. 51.9%) (p<0.001 for all). Inpatient admission/transfer rates declined from 20.1% to 9.2% (p<0.001). Mean ED charges increased from $2458 to $4953 (p<0.001). Older and privately insured endometriosis patients who visited metro-teaching hospitals were more likely to be admitted/transferred and had higher ED charges. During 2006–2015, the number of ED visits for endometriosis remained stable, the inpatient admission/transfer rate declined by half, and mean charges per visit doubled.