269550 To ER is human: Using patient surveys to identify actionable causes underlying unnecessary use of emergency rooms by patients in a large urban Medicaid health plan

Monday, October 29, 2012 : 8:50 AM - 9:10 AM

S. Rae Starr, MPhil, MOrgBehav , HealthCare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Jacky Walker, BA , L.A. Care Health Plan, Los Angeles, CA
Brenda Ramirez, BA , Communications & Marketing, L.A. Care Health Plan, Los Angeles, CA
Carla J. Singleton, BA, MA , L.A. Care Health Plan, Los Angeles, CA
Patricia Mowlavi, MBA , L.A. Care Health Plan, Los Angeles, CA
As more patients access healthcare delivery systems, administrators seek ways to use resources more efficiently. Preventable emergency room (ER) visits are often a focus in efforts to curb healthcare costs. Explanations variously fault patients for making inefficient choices; or fault primary care clinics for delays in access that implicitly divert patients to emergency rooms for primary care.

(1) Study design: This 2011 study used a survey of randomly selected members to examine the patients' self-reported prevalence of ER use and the reasons given by patients for using the ER. The study used the Patient Assessment Survey (PAS), augmented with supplemental questions on ER use.

(2) Setting: The data come from Medicaid members in 2011 at a large urban Medicaid health plan in the southwestern United States, serving a diverse population.

(3) Findings: This briefing reports rates of ER use among patients. Patients were asked about ER use other than for serious illness or injury, and the reasons why they went to the ER instead of other sources for primary care. Patients were also offered a mix of serious and non-serious medical situations, and asked for which of the hypothetical situations they would go to the ER.

(4) Analysis: Patients' accuracy in identifying appropriate circumstances for using the ER were correlated with self-reported frequency of ER use. Reasons given for unnecessary ER visits were broken down by demographics as information for defining health education curricula on the topic for patients and providers. The relative frequency of reasons arising from personal choice versus reasons arising from non-availability of primary care were compared as information for defining appropriate instruction and feedback for providers and patients. This study correlates causes of unnecessary ER visits with the scores that patients give to health plans and doctors. These associations determine whether patients associate unnecessary ER use with poorer quality health care access.

(5) Implications for action: Findings of reasons of personal choice for unnecessary ER visits are useful in guiding health education efforts. Findings on systemic reasons for such visits, provide meaningful feedback to providers and medical groups about improving access to primary care.

Learning Areas:
Administer health education strategies, interventions and programs
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Social and behavioral sciences

Learning Objectives:
Describe rates of unnecessary use of emergency room (ER) services among Medicaid members. Describe patients' reasons leading to unnecessary use of ERs. Identify systemic reasons contributing to unnecessary ER use. Discuss the relative frequency of intrinsic (personal choice) reasons for unnecessary ER visits versus extrinsic (systemic) reasons for unnecessary ER visits. Discuss the degree of health literacy exhibited by members in describing circumstances when ER visits are justified. Analyze improper ER use, broken down by demographics, toward design and targeting of health education programs. Describe whether or not there is an association among improper ER use, its causes, and the ratings that patients give health plans, doctors, and the care that patients receive.

Keywords: Emergency Department/Room, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Served six years as Senior Biostatistician at the largest public health plan in the United States serving Medicaid and CHIP populations in an ethnically diverse urban county in the southwest United States. Managed CAHPS and related surveys from 2006 to 2012 to obtain actionable information to guide the design of interventions to improve the quality of services. Designed survey questions to determine patients' reasons for emergency room use for non-emergency conditions.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.