Abstract
BackgroundNonurgent use of hospital emergency departments (ED) is a controversial topic. It is thought to increase healthcare costs and reduce quality, but is also considered a symptom of unequal access to health care. In this article, we investigate whether convenience (as proxied by travel distances to the hospital ED and to the closest federally qualified health center) is associated with nonurgent ED use, and whether evidence of health disparities exist in the way vulnerable populations use the hospital ED for medical care in South Carolina.MethodsOur data includes 6,592,501 ED visits in South Carolina between 2005 and 2010 from the South Carolina Budget Control Board and Office of Research and Statistics. All ED visits by South Carolina residents with unmasked variables and nonmissing urgency measures, or approximately 76 % of all ED visits, are used in the analysis. We perform multivariable linear regressions to estimate correlations between (1) travel distances and observable sociodemographic characteristics and (2) measures of nonurgent ED use or frequent nonurgent ED use, as defined by the New York University ED Algorithm.ResultsPatients with commercial private insurance, self-pay patients, and patients with other payment sources have lower measures of nonurgent ED use the further away the ED facility is from the patients’ home address. Vulnerable populations, particularly African American and Medicaid patients, have higher measures of nonurgent ED scores, and are more frequent users of the ED for both nonurgent and urgent reasons in South Carolina. At the same time, African Americans visit the hospital ED for medical conditions with higher primary care-preventable scores.ConclusionsContrary to popular belief, convenient access (in terms of travel distances) to hospital ED is correlated with less-urgent ED use among privately insured patients and self-pay patients in South Carolina, but not publicly insured patients. Unequal access to primary care appears to exist, as suggested by African American patients’ use of the hospital ED for primary care-treatable conditions while experiencing more frequent and more severe primary care-preventable conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0864-6) contains supplementary material, which is available to authorized users.
Highlights
Nonurgent use of hospital emergency departments (ED) is a controversial topic
To investigate patient choices of treatment facilities near their residence, we restricted our sample to South Carolina residents based on their residential zip code, and dropped observations with missing variables or apparently incorrect admission dates, which resulted in a total of 6,592,501 ED observations in our analytical sample (76 % of the full sample)
This algorithm was developed by a panel of ED and primary care physicians who analyzed the records of approximately 6,000 ED visits in New York area hospitals in 1988 and assigned a value between 0 % and 100 % that represents the percentage of cases with a particular ICD9 code to be: (1) nonemergent (NE: immediate care not required within 12 h); (2) primary care treatable (PCT: care is required within 12 h, but could have been treated safely in an outpatient setting); (3) primary care preventable (PCP: emergency care is required, but could potentially have been avoided with timely and appropriate ambulatory care); and (4) emergent/unavoidable (EUA: emergency care required, and could not have been avoided with ambulatory care)
Summary
Nonurgent use of hospital emergency departments (ED) is a controversial topic. It is thought to increase healthcare costs and reduce quality, but is considered a symptom of unequal access to health care. Visiting hospital emergency departments (ED) for nonurgent medical conditions is a controversial topic. Conservative estimates place nonurgent ED use at 8 % of annual ED visits, by patients of all payer and age groups, and contrary to popular belief, even by patients with a usual place of care [2]. Many consider nonurgent use of the hospital ED as a symptom of barriers to primary care access for vulnerable populations [11,12,13,14]
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