Disparities in potentially avoidable hospital care: Emergency department visits for ambulatory care sensitive conditions

Background: Hospital care for ambulatory care sensitive conditions (ACSC) is potentially avoidable and often viewed as an indicator of suboptimal primary care. Studies of disparities in hospital care for ACSC typically use inpatient hospital data. However, hospital care for ACSC also occurs in emergency department (ED) settings. Analysis of ED data provides a more complete understanding of hospital care for ACSC. Methods: Data for 42,108 ED visits by adults ages 18 to 64 were obtained from the 2007/2008 National Hospital Ambulatory Medical Care Survey. Outcomes were ACSC visits (operationalized as all-cause, acute/chronic, cause-specific) determined from the primary ED diagnosis. Disparity groups were defined by individual, geographic, and neighborhood level factors. Design-based F-tests were used to test differences in ACSC rates. Multivariate logistic regression was used to estimate the odds of all-cause, acute, and chronic ACSC visits. Analyses were conducted with Stata and accounted for the complex survey design. Results: Overall, 8.2% of ED visits were for ACSC, representing nearly 6 million potentially avoidable ED visits annually. ACSC visits were more likely to be made by patients who were female, older, publicly insured, and from socioeconomically disadvantaged neighborhoods. In multivariate models, significant differences in ACSC visits occurred across several disparity domains, although the magnitude depended on the outcome variable examined. Conclusions: Disparities in potentially avoidable hospital care exist especially for chronic ACSC, suggesting gaps in chronic disease management being bridged by ED care. Identifying determinants of ED visits for ACSC may reduce avoidable hospital care, mitigate healthcare disparities, and lower costs.