Access to Emergency Care in the United States

Carr, Brendan G.; Branas, Charles C.; Metlay, Joshua P.; Sullivan, Ashley F.; Camargo, Carlos A.

doi:10.1016/j.annemergmed.2008.11.016

Cited by 142 publications

(143 citation statements)

References 18 publications

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“…Prior studies of utilization as a function of spatial access have focused on in-person specialty care [15][16][17][18][19]. Our finding of decreased probability of in-person specialty pain care utilization as distance increases is consistent with those prior studies [15][16][17][18][19].…”

Section: Discussionsupporting

confidence: 83%

“…Our finding of decreased probability of in-person specialty pain care utilization as distance increases is consistent with those prior studies [15][16][17][18][19]. Among rural patients in North Carolina, increasing distance to care was conversely associated with regular and chronic care utilization, although not acute care utilization [19].…”

Section: Discussionsupporting

confidence: 82%

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Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

et al. 2016

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Abstract-In 2011, the Veterans Health Administration (VHA) implemented a pilot telementoring program across seven healthcare networks called the Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) for pain management. A VHA healthcare network is a group of hospitals and clinics administratively linked in a geographic area. We created a series of county-level maps in one network displaying (1) the location of Veterans with chronic pain, (2) VHA sites (i.e., coordinating center, other medical centers, outpatient clinics), (3) proportion of Veterans being seen in-person at pain specialty clinics, and (4) proportion of Veterans with access to a primary care provider participating in Pain SCAN-ECHO. We calculated the geodesic distance from Veterans' homes to nearest VHA pain specialty care clinics. We used logistic regression to determine the association between distance and Pain SCAN-ECHO primary care provider participation. Mapping showed counties closer to the Pain SCAN-ECHO coordinating center had a higher rate of Veterans whose providers participated in Pain SCAN-ECHO than those further away. Regression models within networks revealed wide heterogeneity in the reach of Pain SCAN-ECHO to Veterans with low spatial access to pain care. Using geographic information systems can reveal the spatial reach of technology-based healthcare programs and inform future expansion.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 82%

Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

et al. 2016

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“…77,78 Regional differences in access to care may contribute to acute care and outcomes. [79][80][81][82] Although the majority of the US population has access to an emergency department, there are geographic inequities in timely access, particularly in rural regions. [79][80][81] A more detailed review of risk factor profiles, barriers to achieving risk modification goals, patterns of healthcare resource use, and the development of regionalized emergency care delivery systems may provide insights into opportunities to reduce regional variations in disease rates and outcomes.…”

Section: Strokementioning

confidence: 99%

Forecasting the Future of Stroke in the United States

Ovbiagele¹,

Goldstein²,

Higashida³

et al. 2013

Stroke

678

365

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Background and Purpose-Stroke is a leading cause of disability, cognitive impairment, and death in the United States and accounts for 1.7% of national health expenditures. Because the population is aging and the risk of stroke more than doubles for each successive decade after the age of 55 years, these costs are anticipated to rise dramatically. The objective of this report was to project future annual costs of care for stroke from 2012 to 2030 and discuss potential cost reduction strategies. Methods and Results-The American Heart Association/American Stroke Association developed methodology to project the future costs of stroke-related care. Estimates excluded costs associated with other cardiovascular diseases (hypertension, coronary heart disease, and congestive heart failure). By 2030, 3.88% of the US population >18 years of age is projected to have had a stroke. Between 2012 and 2030, real (2010$) total direct annual stroke-related medical costs are expected to increase from $71.55 billion to $184.13 billion. Real indirect annual costs (attributable to lost productivity) are projected to rise from $33.65 billion to $56.54 billion over the same period. Overall, total annual costs of stroke are projected to increase to $240.67 billion by 2030, an increase of 129%. Conclusions-These projections suggest that the annual costs of stroke will increase substantially over the next 2 decades.Greater emphasis on implementing effective preventive, acute care, and rehabilitative services will have both medical and societal benefits. Key Words: AHA Scientific Statements ◼ burden of illness ◼ cost of illness ◼ early medical intervention ◼ epidemiology ◼ ethnicity ◼ healthcare reform ◼ projections and predictions ◼ race ◼ sex ◼ thrombolysis, therapeutic ◼ treatment

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“…9,10,11 After hospital closures occur, ED volume at nearby hospitals increases, 12 but the way in which patients will redistribute to nearby hospitals is not well understood. Geographic distance is known to affect ED utilization, [13][14][15] but few studies have quantitatively analyzed how proximity to hospital closures affects ED volume. 16 With technology advances, especially in geographic information systems, it is now possible to model complex systems and study how events such as hospital closures impact the utilization of EDs distributed throughout a wide region.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

Lee

Carr

Smith

et al. 2015

Population Health Management

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Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

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Access to Emergency Care in the United States

Cited by 142 publications

References 18 publications

Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

Forecasting the Future of Stroke in the United States

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

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