Abstract
Objectives: The objective of this study was to examine overall trends in Emergency Department (ED) visits among adults with and without multiple chronic conditions (MCC) by urgency of visit (nonurgent, urgent, primary care sensitive) and across relevant population subgroups. Methods: Using data from the Nationwide Emergency Department Sample (NEDS) for 2007-2012 maintained by the Healthcare Cost and Utilization Project (HCUP), we examined trends in ED visits among adults who were diagnosed as having no chronic conditions (0CC), one chronic condition (1CC), and MCC based on the Clinical Classification Software codes. Separate trend analyses were conducted for ED visits that were classified as urgent, nonurgent, and primary care sensitive (PCS) based on the New York University (NYU) ED Algorithm. Trend analyses were also conducted for several population subgroups: age, sex, metropolitan hospital status, Census Region, insurance status, and median income quartiles by ZIP code. Results: Between 2007 and 2012, the overall percentage change in nonurgent ED visits made by adults with 0CC, 1CC and MCC were 8.05%, 22.50% and 35.36% respectively (p<0.001 for all categories). Primary Care Sensitive (PCS) ED visits among adults with 0CC, 1CC and MCC increased by 6.53%, 15.49% and 16.53%, respectively, from 2007-2012 (p<0.001 for all categories). Among adults with 0CC, 1CC and MCC, different patterns of growth trends were found for urgent, nonurgent, and PCS ED visits across analyzed population subgroups. Conclusion: The results show that chronic conditions, especially multiple chronic conditions, played a role in the long-term growth of ED visits in general and in nonurgent and primary care sensitive (PCS) ED visits. The increases in nonurgent and PCS visits highlight the importance, as well as opportunities, to reduce potentially avoidable ED visits and unnecessary health care costs, especially as the MCC population is expected to grow in the years ahead.
Highlights
Over the past few decades in the United States, the number of Emergency Department (ED) visits and the prevalence of multiple chronic conditions (MCC) have both been rising steadily [1-3]
Previous work has not examined whether MCCs affect urgent and nonurgent visits differently
We identified the urgency level of each ED visit using the empirically validated NYU ED algorithm developed originally by researchers at New York University who abstracted and reviewed detailed patient information of a sample of almost 6,000 patient records by a panel of emergency physicians in order to determine the urgent nature of the visits [15-17]
Summary
Over the past few decades in the United States, the number of Emergency Department (ED) visits and the prevalence of multiple chronic conditions (MCC) have both been rising steadily [1-3]. Cross-sectional studies have shown that ED use is highest among blacks and Medicaid patients with chronic ambulatory care sensitive (ACS) conditions [1]. The most frequent users of ED services tend to be those with multiple chronic conditions and repeated hospitalizations [3]. Much has been learned, gaps in the understanding of the reasons for the high and rising levels of hospital spending associated with ED visits and the potential for overcrowding still exist. Our study will fill a gap in the ED literature by examining recent nonurgent ED trends with a focus on patients’ chronic conditions at the time of their ED visits
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