Geography, Not Health System Affiliations, Determines Patients’ Revisits to the Emergency Department

Rising, Kristin L.; Karp, David; Powell, Rhea E.; Victor, Timothy W.; Carr, Brendan G.

doi:10.1111/1475-6773.12658

Cited by 13 publications

(8 citation statements)

References 18 publications

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“…48 Returns could span calendar years (and were assigned to the year in which they occurred), but index visits could occur no later than December 1, 2018 to ensure a 30-day follow-up period. Given evidence on revisit capture rates, 49 we flagged returns regardless of whether they occurred at the same hospital as the index visit. We measured overall and nonemergent ED visits as counts and all other outcomes as binary indicators of whether the enrollee experienced the outcome at least once during the year, because ED visits occur much more frequently (multiple visits per person) than other hospital-based care.…”

Section: Discussionmentioning

confidence: 99%

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

Wright

Akiyama

Potter

et al. 2022

Health Services Research

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Objective To examine the relationship between federally qualified health center (FQHC) use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid. Data Sources Data were obtained from 2012 to 2018 Medicare claims. Study Design We modeled hospital‐based care as a function of FQHC use, person‐level factors, a Medicare prospective payment system (PPS) indicator, and ZIP code fixed effects. Outcomes included emergency department (ED) visits (overall and nonemergent), observation stays, hospitalizations (overall and for ambulatory care sensitive conditions), and 30‐day unplanned returns. We stratified all models on the basis of eligibility and rurality. Data Extraction Methods Our sample included individuals dually enrolled in Medicare and Medicaid for at least two full consecutive years, residing in a primary care service area with an FQHC. We excluded individuals without primary care visits, who died, or had end‐stage renal disease. Principal Findings After the Medicare PPS was introduced, FQHC use in rural counties was associated with fewer ED and nonemergent ED visits per 100 person‐years among both age‐eligible (−14.8 [−17.5, −12.1]; −6.6 [−7.5, −5.6]) and disability‐eligible duals (−11.3 [−14.4, −8.3]; −6 [−7.4, −4.6]) as well as a lower probability of observation stays (−0.8 pp age‐eligible; −0.4 pp disability‐eligible) and unplanned returns (−2.1 pp age‐eligible; −1.9 pp disability‐eligible). In urban counties, FQHC use was associated with more ED and nonemergent ED visits per 100 person‐years (10.6 [8.4, 12.8]; 4.0 [2.6, 5.4]) among disability‐eligible duals (a decrease of more than 60% compared with the pre‐PPS period) and increases in the probability of hospitalization (1.1 pp age‐eligible; 0.8 pp disability‐eligible) and ACS hospitalization (0.5 pp age‐eligible; 0.3 pp disability‐eligible) (a decrease of roughly 50% compared with the pre‐PPS period). Conclusions FQHC use is associated with reductions in hospital‐based care among dual enrollees after introduction of the Medicare PPS. Further research is needed to understand how FQHCs can tailor care to best serve this complex population.

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Section: Discussionmentioning

confidence: 99%

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

Wright

Akiyama

Potter

et al. 2022

Health Services Research

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“…Data available to our team did not include administrative claims related to ED use at health systems outside the index institution where this study was performed. Given that acute care utilization patterns are often independent of health system boundaries, especially in the geographic region where this study was performed, which has multiple health systems in one urban region, single‐site administrative data would like underestimate repeat visits. As such, the team decided that patient self‐report was preferable to the alternative of chart review, in which we would miss visits occurring outside the health system.…”

Section: Limitationsmentioning

confidence: 99%

Patient Uncertainty as a Predictor of 30‐day Return Emergency Department Visits: An Observational Study

Rising

LaNoue

Gerolamo³

et al. 2018

Academic Emergency Medicine

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Objective: The objective was to examine the relationship between patient uncertainty at the time of emergency department (ED) discharge as measured by the "Uncertainty Scale" (U-Scale) and 30-day return ED visits. We hypothesized that a higher score on the U-Scale predicts a higher likelihood of a 30-day return ED visit.Methods: This was a cross-sectional single-site pilot study performed with adult patients discharged from an urban academic ED to assess the relationship of U-Scale total and subscale scores with 30-day return ED visits. We collected demographic and U-Scale scores at the time of ED discharge and subsequent 30-day ED utilization data by follow-up telephone call. Results:No association was found between the total U-Scale score and subsequent ED utilization. Patients with higher uncertainty on the Treatment Quality subscale of the U-Scale had higher odds of a 30-day return ED visit (adjusted odds ratio [AOR] = 1.16), while patients with lower uncertainty on the Decision to Seek Care subscale had higher odds of a 30-day return ED visit (AOR = 0.68).

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“…Administrative ED data are often used by policy researchers to address questions about access to care, quality of care, and ED staffing. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 Thus, reliance on inaccurate data sources could hinder or even misinform such research as well as subsequent efforts to improve access to and quality of care.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the American Hospital Association Annual Survey for health services research in emergency medicine

et al. 2022

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Objectives Emergency department (ED) data are often used to address questions about access to and quality of emergency care. Our objective was to compare one of the most commonly used data sources for national ED information, the American Hospital Association (AHA) Annual Survey, with a criterion database: the National Emergency Department Inventory (NEDI)–USA data set. Methods We compared the 2015 and 2016 AHA surveys to the following 3 criterion standards: (1) the 2015 and 2016 NEDI‐USA databases, which have information about all US EDs, including merged data from (2) Council of Teaching Hospitals (COTH) and (3) the Critical Access Hospital (CAH) program. We present descriptive results about the number of EDs in each data set; total and median visit volumes; locations in rural areas; and COTH, CAH, and freestanding ED (FSED) status. Results The AHA survey identified 3893 US EDs in 2015. These EDs had a total annual visit volume of 129,197,493 visits, with a median of 22,772 visits (interquartile range, 8311–47,938). Compared with the NEDI‐USA, the AHA included 1433 fewer EDs (−27%; 95% confidence interval [CI], −28% to −26%) and 23,615,163 (−15%) fewer visits. Specifically, AHA was missing 245 (−22%; 95% CI, −24% to −19%) of those located in rural areas, 268 (−20%; 95% CI, −22% to −18%) in a CAH, and 240 (−47%; 95% CI, −51% to −42%) FSEDs. We saw similar results using 2016 data. Conclusions Although several aggregated results were similar between the compared data sources, the AHA data set excluded many US EDs, including many rural EDs and FSEDs. Consequently, the AHA underreported total ED visits by 15%. We encourage data users to be cautious when interpreting results from any 1 ED data source, including the AHA.

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Geography, Not Health System Affiliations, Determines Patients’ Revisits to the Emergency Department

Abstract: Acute care utilization patterns are often independent of health system boundaries. Current population-based health care models that attribute patients to a single provider or health system may be strengthened by considering geographic patterns of acute care utilization.

Cited by 13 publications

References 18 publications

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

Health center use and hospital‐based care among individuals dually enrolled in Medicare and Medicaid, 2012–2018

Patient Uncertainty as a Predictor of 30‐day Return Emergency Department Visits: An Observational Study

Evaluation of the American Hospital Association Annual Survey for health services research in emergency medicine

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