Is patient satisfaction with ambulatory care systems associated with reduced non-urgent ED use? Empirical evidence from a US nationally representative sample

Objective:

A well-functioning primary care system will have the capacity to provide timely, adequate, and effective care for patients to avoid non-urgent emergency department (ED) use. This study examined how patient satisfaction with ambulatory care systems is associated with reduced non-urgent ED use nationwide.

 

Methods:

This retrospective cohort study used a 2010-2011 national sample, where individuals aged 18 years and older were selected. The patient satisfaction was measured by patient evaluation of providers’ attitudes and care quality of ambulatory care. ED use urgency was determined based on modifications of literature criteria.

The marginal effect following the multivariate logit model was employed to analyze the urgent vs. non-urgent ED use in 2011, after controlling for patient demographic and socioeconomic status in 2010. All predictors were treated as dummy variables.

The lagged time effect was employed to account for the potential endogeneity 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 non-urgent ED use, representing a weighted 8.3 million people nationwide.

In the multivariate logit model, while the measure of providers’ attitudes was not associated with non-urgent ED use (p = 0.748), patient perceived poor and intermediary levels of primary care quality had higher odds of a non-urgent ED visit (OR=1.79, p=0.051, marginally significant, and OR=1.63, p=0.022, respectively) compared to high levels of care quality, with a marginal effect (at means) of 10.8% and 9.0% higher predicted probability of non-urgent ED use, respectively.

In addition, both non-Hispanic white compared with other races, and individuals older than 65 years compared with those aged between 18 and 34 years had lower odds of a non-urgent ED visit (OR=0.46, p=0.032, and OR=0.32, p<0.001, respectively), while moderately sick patients compared with sick patients had higher odds of a non-urgent ED visit (OR=1.58, p=0.049).

Conclusions:

Patients’ perceived primary care quality played an important role in their decision of non-urgent ED use, while ambulatory care providers’ attitudes did not.

These findings highlight the target areas within ambulatory care systems and inform policies of effective strategies in reducing non-urgent ED use. Without improving ambulatory care quality, endeavors simply aiming to improve providers’ hospitality, respects, or patience may not be adequate and effective in improving healthcare system efficiency.