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Denham A, Hill EL, Raven M, Mendoza M, Raz M, Veazie PJ. Is the emergency department used as a substitute or a complement to primary care in Medicaid? HEALTH ECONOMICS, POLICY, AND LAW 2024; 19:73-91. [PMID: 37870129 DOI: 10.1017/s1744133123000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Policies to decrease low-acuity emergency department (ED) use have traditionally assumed that EDs are a substitute for unavailable primary care (PC). However, such policies can exacerbate ED overcrowding, rather than ameliorate it, if patients use EDs to complement, rather than substitute, their PC use. We tested whether Medicaid managed care enrolees visit the ED for nonemergent and PC treatable conditions to substitute for or to complement PC. Based on consumer choice theory, we modelled county-level monthly ED visit rate as a function of PC supply and used 2012-2015 New York Statewide Planning and Research Cooperative System (SPARCS) outpatient data and non-linear least squares method to test substitution vs complementarity. In the post-Medicaid expansion period (2014-2015), ED and PC are substitutes state-wide, but are complements in highly urban and poorer counties during nights and weekends. There is no evidence of complementarity before the expansion (2012-2013). Analyses by PC provider demonstrate that the relationship between ED and PC differs depending on whether PC is provided by physicians or advanced practice providers. Policies to reduce low-acuity ED use via improved PC access in Medicaid are likely to be most effective if they focus on increasing actual appointment availability, ideally by physicians, in areas with low PC provider supply. Different aspects of PC access may be differently related to low-acuity ED use.
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Affiliation(s)
- Alina Denham
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA
| | - Elaine L Hill
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, USA
| | - Maria Raven
- Department of Emergency Medicine, School of Medicine, University of California, San Francisco, USA
| | - Michael Mendoza
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, USA
- Department of Family Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, USA
| | - Mical Raz
- Department of History, University of Rochester, Rochester, USA
- Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, USA
| | - Peter J Veazie
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, USA
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2
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Strum RP, Drennan IR, Mowbray FI, Mondoux S, Worster A, Babe G, Costa AP. Increased demand for paramedic transports to the emergency department in Ontario, Canada: a population-level descriptive study from 2010 to 2019. CAN J EMERG MED 2022; 24:742-750. [PMID: 35984572 PMCID: PMC9389513 DOI: 10.1007/s43678-022-00363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Purpose We examined changes in annual paramedic transport incidence over the ten years prior to COVID-19 in comparison to increases in population growth and emergency department (ED) visitation by walk-in. Methods We conducted a population-level cohort study using the National Ambulatory Care Reporting System from January 1, 2010 to December 31, 2019 in Ontario, Canada. We included all patients triaged in the ED who arrived by either paramedic transport or walk-in. We clustered geographical regions using the Local Health Integration Network boundaries. Descriptive statistics, rate ratios (RR), and 95% confidence intervals were calculated to explore population-adjusted changes in transport volumes. Results Overall incidence of paramedic transports increased by 38.3% (n = 264,134), exceeding population growth fourfold (9.4%) and walk-in ED visitation threefold (13.4%). Population-adjusted transport rates increased by 26.2% (rate ratio 1.26, 95% CI 1.26–1.27) compared to 3.4% for ED visit by walk-in (rate ratio 1.03, 95% CI 1.03–1.04). Patient and visit characteristics remained consistent (age, gender, triage acuity, number of comorbidities, ED disposition, 30-day repeat ED visits) across the years of study. The majority of transports in 2019 had non-emergent triage scores (60.0%) and were discharged home directly from the ED (63.7%). The largest users were persons aged 65 or greater (43.7%). The majority of transports occurred in urbanized regions, though rural and northern regions experienced similar paramedic transport growth rates. Conclusion There was a substantial increase in the demand for paramedic transportation. Growth in paramedic demand outpaced population growth markedly and may continue to surge alongside population aging. Increases in the rate of paramedic transports per population were not bound to urbanized regions, but were province-wide. Our findings indicate a mounting need to develop innovative solutions to meet the increased demand on paramedic services and to implement long-term strategies across provincial paramedic systems.
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Affiliation(s)
- Ryan P Strum
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Ian R Drennan
- Department of Family and Community Medicine, Division of Emergency Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Hospital, Toronto, ON, Canada
| | - Fabrice I Mowbray
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Shawn Mondoux
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Glenda Babe
- Institute for Clinical Evaluative Sciences, McMaster University, Hamilton, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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Buttorff C, Heins SE, Al-Ibrahim H. Changing Care Settings for Injuries. Med Care Res Rev 2022; 79:861-870. [PMID: 35293244 DOI: 10.1177/10775587221081698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tracking injury rates is important for surveillance purposes but little data exist for injuries outside of emergency department visits. We assess the share and type of injuries reported in urgent care centers (UCCs) compared with other settings. We used FAIR Health claims data from 2016 through the first quarter of 2019 to calculate the percent of claims and most common types of injuries. Of the 197 million injury claims, 62% occurred in office settings and 17% in hospital outpatient departments (HOPDs), 5% in inpatient and in ED settings, and less than 2% in UCCs. Injury claims in UCCs increased 6% from 2016 to 2018, whereas injury claims in EDs declined 24%. Overall, physician offices and HOPDs accounted for the largest share of injury care, but UCCs represented the fastest growing setting to treat injuries.
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Strum RP, Tavares W, Worster A, Griffith LE, Costa AP. Emergency department interventions that could be conducted in subacute care settings for patients with nonemergent conditions transported by paramedics: a modified Delphi study. CMAJ Open 2022; 10:E1-E7. [PMID: 35017171 PMCID: PMC8758169 DOI: 10.9778/cmajo.20210148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As the number of patients with nonemergent conditions who are transported by paramedics continues to increase in Ontario, redirecting specific patients to subacute settings may be more beneficial and suitable for both patients and emergency departments. We aimed to evaluate whether emergency department interventions conducted on patients with nonemergent conditions who are transported by paramedics could be conducted in subacute health centres. METHODS We conducted a RAND/UCLA modified Delphi study in Ontario between Oct. 13 and Dec. 19, 2020. We used purposive sampling to recruit practising emergency and primary care physicians for an expert panel. We abstracted interventions given to adult patients with nonemergent conditions (18 yr of age or older) who were transported by paramedics to an emergency department from the National Ambulatory Care Reporting System (NACRS) database (Jan. 1, 2014, to Mar. 31, 2018). Participants in the expert panel rated the suitability of the 150 most frequently recorded emergency department interventions from the NACRS database, for completion in subacute health care centres. We set consensus at 70% agreement. RESULTS We invited 25 physician experts, 21 of whom consented to participate; 20 physicians completed round 1, and 18 physicians completed both rounds. After 2 rounds, consensus was reached on 146 (97.3%) interventions; 103 interventions (68.7%) were suitable for subacute centres, 43 (28.7%) for only the emergency department and 4 (2.6%) did not receive consensus. For subacute centres, all 103 interventions were rated for urgent care centres; walk-in medical centres were applicable for 46 (30.6%) interventions and clinics led by nurse practitioners for 47 (31.3%) interventions. INTERPRETATION Most interventions provided to patients with nonemergent conditions transported by paramedics to emergency departments were identified as suitable for urgent care clinics, with one-third being suitable for either walk-in medical centres or clinics led by nurse practitioners. This study has potential to inform a patient classification model for paramedic-initiated redirection of patients from emergency departments, although further contextualization is required for this to be implemented in clinical practice. STUDY REGISTRATION ID ISRCTN22901977.
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Affiliation(s)
- Ryan P Strum
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster Institute for Research and Aging (Griffith), Emergency Medicine Division (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont.
| | - Walter Tavares
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster Institute for Research and Aging (Griffith), Emergency Medicine Division (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster Institute for Research and Aging (Griffith), Emergency Medicine Division (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster Institute for Research and Aging (Griffith), Emergency Medicine Division (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact (Strum, Worster, Griffith, Costa), McMaster Institute for Research and Aging (Griffith), Emergency Medicine Division (Worster), Department of Medicine, and Department of Medicine (Costa), McMaster University, Hamilton, Ont.; The Wilson Centre (Tavares), University of Toronto, Toronto, Ont.; York Region Paramedic and Senior Services (Tavares), Regional Municipality of York, Newmarket, Ont
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Bitter CC, Zhang Z, Talbert AW, Weber AK, Hinyard L. Firework injuries are increasing in the United States: An analysis of the National Emergency Department Sample. J Am Coll Emerg Physicians Open 2021; 2:e12600. [PMID: 34918008 PMCID: PMC8641913 DOI: 10.1002/emp2.12600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Firework-related injuries cause significant morbidity to persons in the United States and globally. Prior studies have shown that hands and eyes are frequently injured, with loss of hand function and blindness being common after serious injury. Many jurisdictions in the United States have relaxed laws governing sales of consumer fireworks in recent years. Given the increased availability of consumer fireworks, we sought to determine the incidence of firework-related injuries compared with historical controls. METHODS Firework-related injuries were identified in the National Emergency Department Sample (NEDS) using the corresponding International Classification of Disease codes for the years 2008-2017. Demographics, timing of presentation, and hospital characteristics were analyzed. Data were weighted to approximate population estimates of injury. Statistical analyses were completed using SAS. The National Electronic Surveillance System was also queried for firework-related visits to check for consistency in observed trends. RESULTS There were an estimated 7699 injuries attributed to fireworks in 2017 (2.37 per 100,000 population) compared with 5727 (1.88 per 100,000 population) in 2008. The majority of victims were male (74.6%), and injuries clustered in the pediatric and young adult age groups. The Midwest and South (both 38.1%) had more firework-related injuries compared with the West (15.6%) and Northeast (8.2%) regions. Most visits occurred in July (71.4%) with smaller peaks in June (6.9%) and January (6.0%). Patients were disproportionately seen in trauma centers (34.0%) and teaching hospitals (49.6%). CONCLUSION Emergency department visits for firework injuries are increasing in the United States. Pediatric patients and young adult males comprise the majority of victims. Injuries are clustered around the Fourth of July and New Year's holidays. Public health interventions targeted at high-risk groups may reduce the burden of injury.
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Affiliation(s)
- Cindy C. Bitter
- Division of Emergency MedicineSaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Zidong Zhang
- Department Health and Clinical Outcomes Research, Advanced HEAlth Data (AHEAD) Research InstituteSaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Andrew W. Talbert
- Division of Emergency MedicineSaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Alizabeth K. Weber
- Division of OtolaryngologySaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Leslie Hinyard
- Department Health and Clinical Outcomes Research, Advanced HEAlth Data (AHEAD) Research InstituteSaint Louis University School of MedicineSt. LouisMissouriUSA
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Marco CA, Courtney DM, Ling LJ, Salsberg E, Reisdorff EJ, Gallahue FE, Suter RE, Muelleman R, Chappell B, Evans DD, Vafaie N, Richwine C. The Emergency Medicine Physician Workforce: Projections for 2030. Ann Emerg Med 2021; 78:726-737. [PMID: 34353653 DOI: 10.1016/j.annemergmed.2021.05.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE The goals of this study were to determine the current and projected supply in 2030 of contributors to emergency care, including emergency residency-trained and board-certified physicians, other physicians, nurse practitioners, and physician assistants. In addition, this study was designed to determine the current and projected demand for residency-trained, board-certified emergency physicians. METHODS To forecast future workforce supply and demand, sources of existing data were used, assumptions based on past and potential future trends were determined, and a sensitivity analysis was conducted to determine how the final forecast would be subject to variance in the baseline inputs and assumptions. Methods included: (1) estimates of the baseline workforce supply of physicians, nurse practitioners, and physician assistants; (2) estimates of future changes in the raw numbers of persons entering and leaving that workforce; (3) estimates of the productivity of the workforce; and (4) estimates of the demand for emergency care services. The methodology assumes supply equals demand in the base year and estimates the change between the base year and 2030; it then compares supply and demand in 2030 under different scenarios. RESULTS The task force consensus was that the most likely future scenario is described by: 2% annual graduate medical education growth, 3% annual emergency physician attrition, 20% encounters seen by a nurse practitioner or physician assistant, and 11% increase in emergency department visits relative to 2018. This scenario would result in a surplus of 7,845 emergency physicians in 2030. CONCLUSION The specialty of emergency medicine is facing the likely oversupply of emergency physicians in 2030. The factors leading to this include the increasing supply of and changing demand for emergency physicians. An organized, collective approach to a balanced workforce by the specialty of emergency medicine is imperative.
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Affiliation(s)
- Catherine A Marco
- Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH.
| | - D Mark Courtney
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Louis J Ling
- Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - Edward Salsberg
- George Washington University Fitzhugh Mullan Institute for Health Workforce Equity, Washington, DC
| | | | - Fiona E Gallahue
- Department of Emergency Medicine, The University of Washington, Seattle, WA
| | - Robert E Suter
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX; Department of Community Medicine, Oklahoma State University, Tulsa, OK; Department of Military Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Robert Muelleman
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Bradley Chappell
- Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Nathan Vafaie
- Emergency Medicine Residents' Association (EMRA), Dallas, TX
| | - Chelsea Richwine
- George Washington University Fitzhugh Mullan Institute for Health Workforce Equity, Washington, DC
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Zeltzer D, Einav L, Chasid A, Balicer RD. Supply-side variation in the use of emergency departments. JOURNAL OF HEALTH ECONOMICS 2021; 78:102453. [PMID: 33964651 DOI: 10.1016/j.jhealeco.2021.102453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
We study the role of person- and place-specific factors in explaining geographic variation in emergency department utilization using detailed data on 150,000 patients who moved regions within Israel. We document that about half of the destination-origin differences in the average emergency department utilization rate across districts translates to the change (up or down) in movers' propensity to visit the emergency department. In contrast, we find no change in the probability of having a hospital admission through the emergency department. Similar results are obtained in a complementary event study, which uses hospital entry as a source of variation. The results from both approaches suggest that supply-side variation in emergency department access affects only the less severe cases-for which close substitutes likely exist-and that variation across emergency physicians in their propensity to admit patients is not explained by place-specific factors, such as differences in incentives, capacity, or diagnostic quality.
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Affiliation(s)
- Dan Zeltzer
- Berglas School of Economics, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Liran Einav
- Department of Economics, Stanford University, Stanford, CA, United States; NBER, Cambridge, MA, United States.
| | - Avichai Chasid
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel; Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University, Beersheba, Israel.
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Strum RP, Tavares W, Worster A, Griffith LE, Rahim A, Costa AP. Development of the PriCARE classification for potentially preventable emergency department visits by ambulance: a RAND/UCLA modified Delphi study protocol. BMJ Open 2021; 11:e045351. [PMID: 33472792 PMCID: PMC7818828 DOI: 10.1136/bmjopen-2020-045351] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Ontario ambulances are restricted from patient transportation to sub-acute levels of care when these facilities may be more suitable than emergency departments for non-emergent conditions. There is no known patient classification specifically constructed to inform ED diversion protocols and guidance for sub-acute centre transportation for primary care-like patient conditions. OBJECTIVE To construct a novel patient classification of potentially preventable emergency department visits following transport by ambulance, and analyse patient-level characteristic associations with this classification based in Ontario secondary data. METHODS AND ANALYSIS The Primary Care-like Ambulance transports following Response for 911-Emergencies (PriCARE) patient classification will be constructed using a two-phase RAND/UCLA modified Delphi design. All experts included are physicians with relevant experience in emergency and/or primary care in Ontario. The first phase of the study will determine consensus of the expert committee on which ED interventions performed on patients with non-emergent acuities could be conducted in sub-acute healthcare centres. The second phase will assess consensus of which patient, hospital and acuity factors are most appropriate to be incorporated into a PriCARE classification. We will also investigate secondary outcomes on consensus of which ED interventions could be transferred to a paramedic context given an expanded scope of practice and patient-level characteristics of PriCARE classified individuals. ETHICS AND DISSEMINATION This study received a research ethics board exemption waiver from the Hamilton Integrated Research Ethics Board; review reference 2020-11451-GRA. Results will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. The results will be shared with Ontario paramedic services and governing institutions. This study will be used to inform patient classification protocols and clinical decision tools for ambulances to transport to sub-acute healthcare centres. TRIAL REGISTRATION NUMBER ISRCTN22901977.
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Affiliation(s)
- Ryan P Strum
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Walter Tavares
- The Wilson Centre and Post MD Education, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Worster
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmad Rahim
- Institute for Clinical Evaluative Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
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Chacko J, Podlog M, Basile J, Anjum A, Youssef E, Malizia R, Berwald N, Hahn B. Resource utilization of adult patients referred to the emergency department from an urgent care center. Hosp Pract (1995) 2020; 48:272-275. [PMID: 32654538 DOI: 10.1080/21548331.2020.1795483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The rise of urgent care centers (UCC) continues to serve as an alternative to emergency departments (ED) for patients with a perceived lower acuity complaint. Patients that are deemed to be higher acuity are often evaluated at an UCC and then redirected to EDs. However, limited data exist on resource utilization by patients who are transferred from UCCs to EDs. The objective of this study was to compare resource utilization in the ED between patients who were transferred from UCCs and those who were initially evaluated in the ED. METHODS This was a retrospective study of adult patients transferred from UCCs in Staten Island, NY to Staten Island University Hospital, between 1 March 2018 and 31 December 2018. The first group (UCC Group) included those initially evaluated at an UCC and then referred to the ED. The second group (ED Group) included those who had their initial evaluation in the ED. RESULTS 572 subjects were enrolled in the UCC Group, and 84,481 in the ED Group. The UCC Group was more likely to undergo laboratory tests, plain radiographs and computed tomography, electrocardiograms, intravenous fluids, and parenteral medications. Patients in the UCC group were also more likely to be admitted to an inpatient bed or placed into ED observation (p < 0.0001). Overall, ED length of stay was longer in the UCC Group (p < 0.001). CONCLUSIONS Patients referred from an UCC required more ED resources and were more likely to be admitted to a hospital bed compared to those who initially self-referred to the ED.
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Affiliation(s)
- Jerel Chacko
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Mikhail Podlog
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Joseph Basile
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Ahad Anjum
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Elias Youssef
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Robert Malizia
- From GoHealth Urgent Care, Northwell Health , Staten Island, NY, USA
| | - Nicole Berwald
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
| | - Barry Hahn
- From the Department of Emergency Medicine, Staten Island University Hospital, Northwell Health , Staten Island, NY, USA
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Heinert SW, Mumford M, Kim SE, Hossain MM, Amashta ML, Massey MA. User Characteristics of a Low-Acuity Emergency Department Alternative for Low-Income Patients. West J Emerg Med 2020; 21:162-171. [PMID: 33207162 PMCID: PMC7673865 DOI: 10.5811/westjem.2020.8.47970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Emergency department (ED) use for healthcare that can be treated elsewhere is costly to the healthcare system. However, convenience settings such as urgent care centers (UCC) are generally inaccessible to low-income patients. Housing an UCC within a federally qualified health center (FQHC UCC) provides an accessible convenience setting for low-income patients. In 2014 a FQHC UCC opened two blocks from an ED in the same health system. Our goal was to compare characteristics, access to care, and utilization preferences for FQHC UCC and low-acuity ED patients through retrospective chart review and prospective surveying. Methods We completed a retrospective chart review of all patients from March 1, 2018–March 1, 2019, and compared characteristics of low-acuity ED patients (N = 3,911) and FQHC UCC patients (N = 12,571). We also surveyed FQHC UCC patients (N = 201) and low-acuity ED patients (N = 198) from January–July 2019. Results Half of FQHC UCC patients had private insurance. Of ED patients, 29% were aware of the FQHC UCC. Both groups had similar rates of primary care providers. The most common reason for choosing the ED was perceived severity, and for choosing a FQHC UCC was speed. Conclusion These findings show similarities and differences between these two patient populations. Future research is needed to determine utilization patterns and in-depth reasons behind them. Interventions that help patients decide where to go for low-acuity care may create more utilization efficiency.
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Affiliation(s)
- Sara W Heinert
- University of Illinois at Chicago, Department of Emergency Medicine, Chicago, Illinois
| | - Melody Mumford
- University of Illinois at Chicago, Mile Square Health Center, Chicago, Illinois
| | - Sarah E Kim
- University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Muhammad M Hossain
- University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Michael L Amashta
- University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Maria A Massey
- University of Illinois at Chicago, College of Medicine, Chicago, Illinois
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11
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Urgent Care Centers Delay Emergent Surgical Care Based on Patient Insurance Status in The United States. Ann Surg 2020; 272:548-553. [DOI: 10.1097/sla.0000000000004373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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