Online Program

Illinois Emergency Department Utilization: Patterns and Trends in Access to Care and Health Equity

Monday, November 2, 2015

Barbara Fischer, RN, Division of Patient Safety and Quality, Illinois Department of Public Health, Chicago, IL
Anh-Thu Runez, MPH, Division of Patient Safety and Quality, Illinois Department of Public Health, Chicago, IL
Mary Driscoll, RN, MPH, Division of Patient Safety and Quality, Illinois Department of Public Health, Chicago, IL

Emergency Departments (EDs) play a pivotal role in the nation's healthcare safety net.  Increasing ED utilization has raised concerns about inappropriate use, delayed emergent care and excess costs. To contribute to state healthcare reform planning, Illinois ED utilization was examined with particular emphasis on access to care and health equity. 


Outpatient ED visits from 2009-2013 were analyzed using ED discharge data, and visits separated into general categories including Potentially Primary Care Preventable ( PPCP) and behavioral health using an algorithm developed by New York University.  Poisson regression was used to compare visits across time and race/ethnicity.


 Between 2009 and 2013 overall ED visit volume increased 4% while PPCP visits increased 2%.  PPCP visits consistently accounted for 50-52% of total visits.  Although behavioral health related visits accounted for <4% of total ED visits, they increased 30% during study period.  In 2013, black people had higher rates than whites for total ED visits (RR=2.38), PPCP visits (RR=2.90) and behavioral health visits (RR=1.78).  These inequities were significant (p<.0001) and evident across all years.


Although total ED visit volume increased modestly, behavioral health visits increased significantly during study period.  PPCP visits consistently accounted for the greatest percentage of visit types.  Black people had disproportionate visit burden compared to whites across visit categories.  These data could indicate difficulty with access to primary and behavioral healthcare, particularly for black people, and can be an important tool for statewide healthcare assessment and planning.

Learning Areas:

Planning of health education strategies, interventions, and programs
Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Describe patterns and trends in access to care and health equities related to emergency department use.

Keyword(s): Health Care Delivery, Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been CO-PI on several CDC public health and prevention grants, project managed a federally funded access to care initiative at large public hospital, first author Health Affairs article on access to specialty care, managed statewide quality initiatives, responsible for state public health department quality/safety public reporting. Over 20 years of clinical practice, 14 years of public health practice, directed departments, and sat on senior leadership team of ambulatory care in public hospital.
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.