141st APHA Annual Meeting

In This section

280500
Determinants of non-urgent utilization of emergency departments: An observational study from California

Monday, November 4, 2013

Brian Chen, JD, PhD , Arnold School of Public Health, University of South Carolina, Columbia, SC
Overuse of the hospital emergency department (ED) for non-urgent medical needs results in $38 billion annually in unnecessary costs to payers and is the third leading cause of health care waste in the United States. More than half of the 120 million annual visits to the ED nationally can be avoided without reducing health outcomes. The use of the ED for non-urgent problems also results in adverse non-financial consequences, such as overcrowding, lower quality and episodic care, and increased mortality and morbidity. Despite an extensive literature examining the determinants, costs and consequences of inappropriate ED utilization, most studies are difficult to translate into policy. Using a rich set of statewide health care data linked to patient sociodemographic information in California, we study the feasibility of reducing ED overutilization in the state by (1) analyzing the role of distances to federally qualified health centers from patient zip codes and the use of ED services for non-urgent medical conditions; (2) discovering predictors of inappropriate ED utilization based on observable patient characteristics; and (3) investigating the association between inappropriate ED utilization and subsequent inpatient admission patterns. The proposed study will address limitations in the generalizability of past research which did not include actual patient utilization data. With information derived from this study, policymakers can target the population most likely to use the ED for non-urgent illnesses and focus on areas where the potential for savings is the greatest.

Learning Areas:
Chronic disease management and prevention
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify sociodemographic factors (race, gender, age, insurance coverage type) associated with non-urgent utilization of emergency department (ED) services Identify the role of distance to federally qualified health centers in the non-urgent utilization of ED services Analyze potential avenues for the reduction of wasteful non-urgent utilization of ED services

Keywords: Health Care Delivery, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the first author and performed the empirical analysis on this article. I have a doctorate in business administration (applied economics) and am trained in the use of the statistical methods used in the analysis.
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.