Abstract
IntroductionUse of the hospital emergency department (ED) for medical conditions not likely to require immediate treatment is a controversial topic. It has been faulted for ED overcrowding, increased expenditures, and decreased quality of care. On the other hand, such avoidable ED utilization may be a manifestation of barriers to primary care access.MethodsA random 10% subsample of all ED visits with unmasked variables, or approximately 7.2% of all ED visits in California between 2006 and 2010 are used in the analysis. Using panel data methods, we employ linear probability and fractional probit models with hospital fixed effects to analyze the associations between avoidable ED utilization in California and observable patient characteristics. We also test whether shorter estimated road distances to the hospital ED are correlated with non-urgent ED utilization, as defined by the New York University ED Algorithm. We then investigate whether proximity of a Federally Qualified Health Center (FQHC) is correlated with reductions in non-urgent ED utilization among Medicaid patients.ResultsWe find that relative to the reference group of adults aged 35–64, younger patients generally have higher scores for non-urgent conditions and lower scores for urgent conditions. However, elderly patients (≥65) use the ED for conditions more likely to be urgent. Relative to male and white patients, respectively, female patients and all identified racial and ethnic minorities use the ED for conditions more likely to be non-urgent. Patients with non-commercial insurance coverage also use the ED for conditions more likely to be non-urgent. Medicare and Medicaid patients who live closer to the hospital ED have higher probability scores for non-emergent visits. However, among Medicaid enrollees, those who live in zip codes with an FQHC within 0.5 mile of the zip code population centroid visit the ED for medical conditions less likely to be non-emergent.ConclusionsThese patterns of ED utilization point to potential barriers to care among historically vulnerable groups, observable even when using rough estimates of travel distances and avoidable ED utilization.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0158-y) contains supplementary material, which is available to authorized users.
Highlights
Use of the hospital emergency department (ED) for medical conditions not likely to require immediate treatment is a controversial topic
It is estimated that avoidable ED visits cost $38 billion annually in the United States [2], a figure that is likely far greater if subsequent intensive or inpatient care could have been averted through access to appropriate and timely primary care [3]
To identify the demographic and geographic distribution of non-emergent, primary care treatable, and primary care preventable ED visits, we identify associations between observable patient characteristics and ED visits with higher probability scores of avoidable ED utilization, using 7.2% of all ED visits in California between 2006 and 2010
Summary
Use of the hospital emergency department (ED) for medical conditions not likely to require immediate treatment is a controversial topic. It has been faulted for ED overcrowding, increased expenditures, and decreased quality of care. Use of the hospital emergency department (ED) for avoidable medical conditions is often faulted for waste and inefficiency, but may be a symptom of challenges in access to health care [1]. The episodic and reactive nature of ED medical care makes it ill-suited as a medical home for chronically ill patients It is of great policy importance to understand the correlates of avoidable ED utilization, at the population level in the most populous state in the United States
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