Emergency Department Overuse

Adams, James G.

doi:10.1001/jama.2013.2476

Cited by 57 publications

(23 citation statements)

References 8 publications

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“…Of particular consideration will be the need to evaluate the mutual effect these alternate models of care (that is, medical homes; managed care plans; accountable care organizations; and organized efforts, such as geriatric emergency departments and the reimbursement policies associated with these programs) have on quality and cost-effectiveness. (22) Research is also needed to understand the generalizability of these approaches. Geriatric-specific modification costs and their effect on the general patient population must be weighed with the potential for benefit.…”

Section: Transforming Emergency Care For Older Adultsmentioning

confidence: 99%

Transforming Emergency Care For Older Adults

et al. 2013

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Already crowded and stressful, US emergency departments are facing the challenge of serving an aging population that requires complex and lengthy evaluations. Creative solutions are necessary to improve the value and ensure the quality of emergency care delivered to older adults while more fully addressing their complex underlying physical, social, cognitive, and situational needs. Developing models of geriatric emergency care, including some that are already in use at dedicated geriatric emergency departments, incorporate a variety of physical, procedural, and staffing changes. Among the options for “geriatricizing” emergency care are approaches that may eliminate the need for an emergency department visit, such as telemedicine; for initial hospitalization, such as patient observation units; and for rehospitalization, such as comprehensive discharge planning. By transforming its current safety-net role to becoming a partner in care coordination, emergency departments have the opportunity to better integrate into the broader health care system, improve patient health outcomes, contribute to optimizing the health care system, and reduce overall costs of care—keys to improving emergency care for patients of all ages.

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Section: Transforming Emergency Care For Older Adultsmentioning

confidence: 99%

Transforming Emergency Care For Older Adults

et al. 2013

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“…2,3 High ED utilization among young adults could reflect many factors, including lack of insurance, limited access to primary care, and redirection from other care facilities. As EDs face cost containment 4 and crowding issues, 5 it is increasingly important for policymakers to address high ED utilization across all populations to improve the efficiency and quality of the health care system.…”

Section: Introductionmentioning

confidence: 99%

Relationship of Affordable Care Act Implementation to Emergency Department Utilization Among Young Adults

Hernandez‐Boussard

Morrison

Goldstein

et al. 2016

Annals of Emergency Medicine

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Study objective The 2010 provision of the Patient Protection and Affordable Care Act (ACA) extended eligibility for health insurance for young adults aged 19 to 25 years. It is unclear, however, how expanded coverage changes health care behavior and promotes efficient use of emergency department (ED) services. Our objective was to use population-level emergency department data to characterize any changes in diagnoses seen in ED among young adults since the implementation of the ACA dependent coverage expansion. Methods We performed a difference-in-differences analysis of 2009 to 2011 ED visits from California, Florida, and New York, using all-capture administrative data to determine how the use of ED services changed for clinical categories after the ACA provision among young adults aged 19 to 25 years compared with slightly older adults unaffected by the provision, aged 26 to 31 years. Results We analyzed a total of 10,158,254 ED visits made by 4,734,409 patients. After the implementation of the 2010 ACA provision, young adults had a relative decrease of 0.5% ED visits per 1,000 people compared with the older group. For the majority of diagnostic categories, young adults’ rates and risk of visit did not change relative to that of slightly older adults after the implementation of the ACA. However, although young adults’ ED visits significantly increased for mental illnesses (2.6%) and diseases of the circulatory system (eg, nonspecific chest pain) (4.8%), visits decreased for pregnancy-related diagnoses and diseases of the skin (eg, cellulitis, abscess) compared with that of the older group (3.7% and 3.1%, respectively). Conclusion Our results indicate that increased coverage has kept young adults out of the ED for specific conditions that can be cared for through access to other channels. As EDs face capacity challenges, these results are encouraging and offer insight into what could be expected under further insurance expansions from health care reform.

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“…A large proportion of the increase in ED use in developed countries may be due to wasteful and inefficient inappropriate visits [14] which, one estimate suggests, may result in overuse costing $38 billion a year in the USA [15,16], with 7-89% of ED visits in different countries reportedly for non-urgent problems susceptible to less specialized care [17]. Factors influencing this situation may include inconsistent definitions of appropriateness and non-urgent triage.…”

Section: Discussionmentioning

confidence: 99%

Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study

et al. 2014

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BackgroundIn Spain, primary healthcare (PHC) referrals for diagnostic procedures are subject to long waiting-times, and physicians and patients often use the emergency department (ED) as a shortcut. We aimed to determine whether patients evaluated at a hospital outpatient quick diagnosis unit (QDU) who were referred to ED from 12 PHC centers could have been directly referred to QDU, thus avoiding ED visits. As a secondary objective, we determined the proportion of QDU patients who might have been evaluated in a less rapid, non-QDU setting.MethodsWe carried out a cross-sectional retrospective cohort study of patients with potentially serious conditions attended by the QDU from December 2007 to December 2012. We established 2 groups of patients: 1) patients referred from PHC to QDU (PHC-QDU group) and 2) patients referred from PHC to ED, then to QDU (PHC-ED-QDU group). Two observers assessed the appropriateness/inappropriateness of each referral using a scoring system. The interobserver agreement was assessed by calculating the kappa index. Multivariate logistic regression analysis was performed to identify the factors associated with the dependent variable ‘ED referral’.ResultsWe evaluated 1186 PHC-QDU and 1004 PHC-ED-QDU patients and estimated that 93.1% of PHC-ED-QDU patients might have been directly referred to QDU. In contrast, 96% of PHC-QDU patients were found to be appropriately referred to QDU first. The agreement for PHC-QDU referrals (PHC-QDU group) was rated as excellent (ϰ = 0.81), while it was rated as good for PHC-ED referrals (PHC-ED-QDU group) (ϰ = 0.75). The mean waiting-time for the first QDU visit was longer in PHC-QDU (4.8 days) than in PHC-ED-QDU (2.6 days) patients (P = .001). On multivariate analysis, anemia (OR 2.87, 95% CI 1.49–4.55, P < .001), rectorrhagia (OR 2.18, 95% CI 1.10–3.77, P = .01) and febrile syndrome (OR 2.53, 95% CI 1.33-4.12, P = .002) were independent factors associated with ED referral. Nearly one-fifth of all QDU patients were found who might have been evaluated in a less rapid, non-QDU setting.ConclusionsMost PHC-ED-QDU patients might have been directly referred to QDU from PHC, avoiding the inconvenience of the ED visit. A stricter definition of QDU evaluation criteria may be needed to improve and hasten PHC referrals.

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Emergency Department Overuse

Cited by 57 publications

References 8 publications

Transforming Emergency Care For Older Adults

Transforming Emergency Care For Older Adults

Relationship of Affordable Care Act Implementation to Emergency Department Utilization Among Young Adults

Primary care referrals of patients with potentially serious diseases to the emergency department or a quick diagnosis unit: a cross-sectional retrospective study

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