303215
Health disparities in non-urgent and frequent utilization of hospital emergency departments in South Carolina: A population-based observational study
To uncover whether travel convenience is associated with non-urgent ED utilization, and whether evidence of health disparities exist in the way vulnerable populations use the hospital ED for medical care.
Methods
All ED visits by South Carolina residents with unmasked variables and estimable urgency measures, or approximately 76% of all ED visits (2006-2010), are used in the analysis. We perform multivariate linear regressions to estimate correlations between (1) travel distances, and observable sociodemographic characteristics and (2) measures of non-urgent ED utilization or frequent non-urgent ED utilization, as defined by the New York University ED Algorithm.
Results
Patients with commercial private insurance, self-pay patients, and patients with other sources of payment have lower measures of non-urgent ED utilization the further away the ED facility is from the patients’ home address. Vulnerable populations, particularly Black and Medicaid patients, have higher measures of non-urgent ED utilization scores and are more frequent users of the ED for non-urgent reasons in South Carolina. At the same time, Black patients use the hospital ED with higher scores of primary care preventable medical conditions.
Conclusions
Contrary to popular belief, convenient access (in terms of travel distances) to hospital ED is correlated with less urgent ED utilization among privately insured patients and self-pay patients, rather than publicly insured patients. Unequal access to primary care appears to exist, as suggested by Black patients’ use of the hospital ED for primary care treatable conditions while experiencing more frequent and more severe primary care preventable conditions.
Learning Areas:
Chronic disease management and preventionProvision of health care to the public
Social and behavioral sciences
Learning Objectives:
Identify the geographical distribution of different measures of avoidable ED utilization in South Carolina by zip code
Assess whether travel convenience (as proxied by travel distances to the hospital emergency department (ED) and to the closest Federally Qualified Health Center) is associated with avoidable ED utilization in South Carolina
Analyze whether evidence of health disparities exist in the way vulnerable populations use the hospital ED for medical care in South Carolina
Describe whether South Carolinians use the ED for different types of medical conditions (primary care treatable or primary care preventable) based on observable socioeconomic characteristics
Assess the construct validity of the New York University ED Algorithm (to identify avoidable ED use) in a population of ED users in South Carolina
Keyword(s): Emergency Medical Services, Health Disparities/Inequities
Qualified on the content I am responsible for because: I received my PhD in public policy and management from the University of California at Berkeley and am trained in the econometric methods used in this study. This study is a result of an internally funded grant to investigate the socioeconomic factors of avoidable ED utilization in South Carolina, and has benefited from the comments and suggestions of ED physicians.
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.