Predictors of Avoidable Emergency Room Visits among High Cost Medicaid Enrollees

Objectives: Research has shown that Medicaid enrollees are the most frequent users of the Emergency Department (ED) services. Several studies have demonstrated that a high proportion of the ED visits could be avoided. We looked into population and health system characteristics associated with avoidable ED visits (AEDV) among a high risk, high cost Medicaid population. Methods: One year claims dataset for a sample of high cost, high risk Medicaid enrollees in Houston, Texas was used for the analysis using the Andersen-Aday theoretical framework for access to health care. ED visits were classified using the New York University algorithm. We estimated monthly rates of utilization variables (AEDV, outpatient visits, etc…). Patient complexity was measured using the Chronic Illness Intensity Index (CI3). We performed logistic regression models to test for significant association between AEDV, and population at risk and health care delivery characteristics. Results: We found that 69% (179) of our population had an ED visits during 2008-2009. Of these visits 60% were classified as AEDV. Women were 33% less likely to have an AEDV per month. Age was negatively associated, with younger patients being more likely to have AEDV. More complex patients were 6.6% more likely to have an AEDV. For every extra physician a patient visited, the probability of having an AEDV per month increased by 2.4%, however this was not significant (p 0.06) Conclusions: Among high cost, high risk Medicaid patients, certain patient characteristics can allow us to identify those at higher risk of having an AEDV.