142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

296880
Can nonurgent emergency department use be reduced? Empirical evidence from a nationally representative sample

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 8:45 AM - 9:00 AM

Haichang Xin, PhD , Department of Health Care Organization and policy, University of Alabama at Birmingham, Birmingham, AL
Meredith Kilgore, PhD , University of Alabama at Birmingham, Birmingham, AL
Bisakha Sen, PhD , School of Public Health, University of Alabama at Birmingham, Birmingham, AL
Justin Blackburn, PhD , Department of Health Care Organization & Policy, University of Alabama at Birmingham, Birmingham, AL
Objective:

A well-functioning primary care system will have the capacity to provide timely, adequate, and effective care for patients to avoid nonurgent emergency department (ED) use. This study examined how access to and quality of ambulatory care is associated with nonurgent ED use nationwide.

 

Methods:

This retrospective cohort study used the 2010-2011 Medical Expenditure Panel Survey data, where individuals aged 18 and older with complete data for all five rounds were selected. This study chose a usual source of care status, perceived convenience to get medical care, and patient evaluation of care quality as the main independent variables that measure access to and quality of ambulatory care.

ED use urgency was determined based on modifications of literature criteria. The multivariate logit model was employed to analyze the urgent vs. nonurgent ED use in 2011, after controlling for age, sex, race, insurance, and rural vs. urban residence in 2010. All predictors were treated as dummy variables.

The lagged time effect was employed to account for the engogeneity between outcomes and predictors. The weights and variance were adjusted using the survey procedures.  

Results:

The final study sample consisted of 1,287 adults with at least one ED visit in 2011, which represented a weighted 29,463,684 people in the total population. Among them, 390 individuals (30.3%) had nonurgent ED use, representing a weighted 8.3 million people nationwide.

In the multivariate logit model, while a usual source of care status and perceived convenience to get medical care were not associated with nonurgent ED use (both at p > 0.05), patient perceived better primary care quality had lower odds of a nonurgent ED visit (OR=0.42, p=0.026), with a marginal effect (at means) of 11.9% lower predicted probability of nonurgent ED use. In addition, non-Hispanic white and black individuals compared with other races also had lower odds of a nonurgent ED visit (both at p < 0.05), with a marginal effect of 24.8% and 17.9% lower predicted probability, respectively.

Conclusions:

Patients’ perceived primary care quality played an important role in their decision of nonurgent ED use, while access to ambulatory care did not.

These findings highlight the target areas and inform policies of effective strategies in reducing nonurgent ED use. Without improving ambulatory care quality, endeavors simply aiming to encourage the use of outpatient clinics, to increase primary care supply, or to increase ED cost sharing levels may not be effective in improving healthcare system efficiency.

Learning Areas:

Biostatistics, economics
Epidemiology
Public health or related public policy
Public health or related research

Learning Objectives:
Analyze how access to and quality of ambulatory care is associated with nonurgent ED use nationwide Identify target areas and policies in reducing nonurgent ED use

Keyword(s): Emergency Medical Services, Economic Analysis

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My background is health services research, and I have developed my expertise in health economics and outcomes, health policies, as well as methodologies. For this study, I have developed the research question, conceptualized the study design, analyzed the data, produced and interpreted results to inform policy.
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.

Back to: 4055.0: Emergency department use