Appropriate use of emergency department (ED) services in Florida: A longitudinal analysis using the NYU ED Algorithm

BACKGROUND: The New York University (NYU) Emergency Department (ED) Algorithm has been used to describe appropriate use of ED services from a cross-sectional analytic view-point, but key questions left unanswered involve inappropriate ED use over time.

METHODS: Our sample includes commercial and government-insured members from a health plan in Florida, across the periods May 2008-April 2009 and May 2009-April 2010. Bi-variable and multi-variable statistics were used to describe the longitudinal evaluation of appropriate ED care seeking.

RESULTS/OUTCOMES: In the initial period, 146,037 members had at least one out-patient ED visit. Of those, 47 % sought these services inappropriately as detected by the NYU ED algorithm. Of the 146,037 members in the initial period, 31,568 had ED visits (21.6%) in both periods. Of those, 26.1% had inappropriate ED visits in each period, 20.9% transitioned to inappropriate use, 21.3% transitioned to appropriate use and 31.7% sought ED services in appropriate ways. Logistic Regression results showed the tendency to seek ED care inappropriately is associated with group insurance, African Americans, Hispanics, members in the South and North West regions of Florida. In addition, transitioning from appropriate to inappropriate ED use is associated with having a preference sensitive condition and being female.

CONCLUSIONS: Over two-years, the relative rate of inappropriate use of ED services was similar for those with ED visits in each year. In addition, there are transitions between appropriate and inappropriate use of ED services. Programs to address appropriate use of ED services need to consider these transitional factors.