The impact of urgent care centers on nonemergent emergency department visits

Abstract

Objective: To estimate the impact of urgent care centers on emergency department (ED) use. Data Sources: Secondary data from a novel urgent care center database, linked to the Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) from six states. Study Design: We used a difference-in-differences design to examine ZIP code-level changes in the acuity mix of emergency department visits when local urgent care centers were open versus closed. ZIP codes with no urgent care centers served as a control group. We tested for differential impacts of urgent care centers according to ED wait time and patient insurance status. Data Collection/Extraction Methods: Urgent care center daily operating times were determined via the urgent care center database. Emergency department visit acuity was assessed by applying the NYU ED algorithm to the SEDD data. Urgent care locations and nearby emergency department encounters were linked via zip code.Principal Findings: We found that having an open urgent care center in a ZIP code reduced the total number of ED visits by residents in that ZIP code by 17.2% (P < 0.05), due largely to decreases in visits for less emergent conditions. This effect was concentrated among visits to EDs with the longest wait times. We found that urgent care centers reduced the total number of uninsured and Medicaid visits to the ED by 21% (P < 0.05) and 29.1% (P < 0.05), respectively. Conclusions:During the hours they are open, urgent care centers appear to be treating patients who otherwise would have visited the ED. This suggests that urgent care centers have the potential to reduce health care expenditures, though questions remain about their net cost impact. Future work should assess whether urgent care centers can improve health care access among populations that often experience barriers to receiving timely care.

Profile and outcomes of emergency department presentations based on mode of arrival: A state‐wide retrospective cohort study

“…Yet, this service acts only on an ‘afterhours’ basis; operationalisation as an urgent care centre geared towards PAT presentation characteristics (early ED shift and lower priority) with patients streamed to this service based on triage recommendations could be beneficial for addressing non‐urgent presentations. Current urgent care centres have demonstrated success internationally, reducing costly non emergent ED visits and increasing access to timely healthcare for patients 26 …”

“…Current urgent care centres have demonstrated success internationally, reducing costly non emergent ED visits and increasing access to timely healthcare for patients. 26…”

Strength in the gap: A rapid review of principles and practices for urgent care centres

“… 15 A study of six American states demonstrated a 17.2% reduction in ED visits during times when UCCs in the corresponding zip code were open. 11 Similarly, areas within the United States with high UCC use have been found to correspond with lower ED use. 16 However, a review of British efforts to increase urgent care availability suggests that individuals do not generally substitute newly established, more appropriate care avenues for older ones, including ED use.…”

“… 9 Lower-acuity care adequacy for many ED presentations is well-established, with up to half manageable outside the ED. 10 , 11 Patients seeking care from general practitioner after-hours services have been found to more often be older, female, and presenting with non-injury concerns compared to ED presentations, suggesting that patients do discriminate when selecting services. 10 However, reduced ED demand is inconsistent among alternative care models.…”

Factors Associated With Avoidable Emergency Department Visits in Broward County, Florida

“…Studies like these show the positive impact that educating the public about the healthcare system can have on ED utilization [26]. Furthermore, increasing numbers of urgent care clinics can also serve to treat patients with non-emergent conditions [27].…”