Emergency department utilization among patients who receive outpatient specialty care for headache: A retrospective cohort study analysis

Abstract

Objectives: To compare clinical characteristics among outpatient headache clinic patients who do and do not self-report visiting the emergency department for headache.Background: Headache is the fourth most common reason for emergency department visits, compromising 1%-3% of visits. Limited data exist about patients who are seen in an outpatient headache clinic but still opt to frequent the emergency department. Clinical characteristics may differ between patients who self-report emergency department use and those who do not. Understanding these differences may help identify which patients are at greatest risk for emergency department overutilization. Methods: This observational cohort study included adults treated at the Cleveland Clinic Headache Center between October 12, 2015 and September 11, 2019, who completed self-reported questionnaires. Associations between self-reported emergency department utilization and demographics, clinical characteristics, and patientreported outcome measures (PROMs: Headache Impact Test [HIT-6], headache days per month, current headache/face pain, Patient Health Questionnaire-9 [PHQ-9], Patient-Reported Outcomes Measurement Information System [PROMIS] Global Health [GH]) were evaluated. Results: Of the 10,073 patients (mean age 44.7 ± 14.9, 78.1% [7872/10,073] female, 80.3% [8087/10,073] White patients) included in the study, 34.5% (3478/10,073) reported visiting the emergency department at least once during the study period. Characteristics significantly associated with self-reported emergency department utilization included younger age (odds ratio = 0.81 [95% CI = 0.78-0.85] per decade), Black patients (vs. White patients) (1.47 [1.26-1.71]), Medicaid (vs. private insurance) (1.50 [1.29-1.74]), and worse area deprivation index (1.04 [1.02-1.07]).

Rural disparities in emergency department utilization for migraine care

“…Within the encounters of the four groups examined, significant differences in demographic and baseline factors exist which may suggest explanations for the observed differences in ED utilization rate. The national rural and Kentucky Appalachian groups had higher proportions of encounters with White patients in accordance with anticipated regional demographics; however, prior research has observed a higher age‐adjusted rate of migraine diagnoses in American Indian/Alaskan Native populations, as well as more frequent ED utilization in Black patients with migraine 1,30,31 . In the context of these other observations, it is unlikely that the White race constitutes a unique risk factor for ED utilization.…”

“…The national rural and Kentucky Appalachian groups had higher proportions of encounters with White patients in accordance with anticipated regional demographics; however, prior research has observed a higher age-adjusted rate of migraine diagnoses in American Indian/Alaskan Native populations, as well as more frequent ED utilization in Black patients with migraine. 1,30,31 In the context of these other observations, it is unlikely that the White race constitutes a unique risk factor for ED utilization. Importantly, lower household income was also present in both groups compared to nonrural populations.…”