Insurance Status and Access to Urgent Ambulatory Care Follow-up Appointments

Asplin, Brent R.; Rhodes, Karin V.; Levy, Helen; Lurie, Nicole; Crain, A. Lauren; Carlin, Bradley P.; Kellermann, Arthur L.

doi:10.1001/jama.294.10.1248

Cited by 243 publications

(207 citation statements)

References 14 publications

(6 reference statements)

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“…This may reflect the expectation that even if patients have a primary provider, getting a timely appointment after ED discharge is not guaranteed. 49 Our finding that a recent ED visit influenced 16 % of moderately/weakly acuity-driven admissions may indicate physicians' concerns that ED re-visitation is a predictor of adverse events or may represent outpatient treatment failure. Both might be mitigated by care coordination, which has been shown to be effective in reducing readmissions in patients discharged from the ED.…”

Section: Discussionmentioning

confidence: 77%

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

et al. 2015

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BACKGROUND:Little is known about the factors that influence physicians' admission decisions, especially among lower acuity patients. For the purpose of our study, non-medical refers to all of the factors-other than the patient's clinical condition-that could potentially influence admission decisions. OBJECTIVE: To describe the influence of non-medical factors on physicians' decisions to admit non-critically ill patients presenting to the ED. DESIGN: Cross-sectional study of hospital admissions at a single academic medical center. PARTICIPANTS: Non-critically ill adult patients admitted to the hospital (n=297) and the admitting emergency medicine physicians (n=34). MAIN MEASURES: A patient survey assessed nonmedical factors, including primary care access and utilization. A physician survey assessed clinical and nonmedical factors influencing the decision to admit. Based on physician responses, admissions were characterized as Bstrongly acuity-driven,^Bmoderately acuity-driven,ô r Bweakly acuity-driven.^Among these admission types, we compared length of stay, cost, and readmission within 30 days to the hospital or ED. KEY RESULTS: Based on the admitting physician's assessment, we categorized the motivation for admission as strongly acuity-driven in 185 (62 %) admissions, moderately acuity-driven in 92 (31 %), and weakly acuity-driven in 20 (7 %). Per the physician surveys, 51 % of hospitalizations were strongly or moderately influenced by one or more non-medical factors, including lack of information about baseline conditions (23 %); inadequate access to outpatient specialty care (14 %); need for a diagnostic testing or procedure (12 %); a recent ED visit (11 %); and inadequate access to primary care (10 %). Compared with strongly-acuity driven admissions, admissions that were moderately or weakly acuity-driven were shorter and less costly but were associated with similar rates of ED (35 %) and hospital (27 %) readmission. CONCLUSIONS: Non-medical factors are influential in the admission decisions for many patients presenting to the emergency department. Moderately and weakly acuity-driven admissions may represent a feasible target for alternative care pathways.KEY WORDS: non-medical factors; hospital admission decision; access to care; care transitions; decision making; emergency medicine; health care delivery; medical decision making; severity of illness; socioeconomic factors; utilization.

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Section: Discussionmentioning

confidence: 77%

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

et al. 2015

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“…8,14 Audit studies, a well-established method of testing for discrimination in labour and housing markets, [15][16][17] have been used in the United States to show that Medicaid recipients and patients who are uninsured encounter substantial barriers to care. [18][19][20][21] However, these effects may be due to the economic incentive of differing levels of reimbursement, rather than discrimination on the basis of socio economic status itself.…”

Section: Discussionmentioning

confidence: 99%

The effect of socioeconomic status on access to primary care: an audit study

Olah

Gaisano

Hwang

2013

CMAJ

114

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“…When emergency physicians can confidently arrange followup care, they feel less compelled to hospitalize medically fragile patients. 45 These effects, if realized, should translate into lower health care costs.…”

Section: -21mentioning

confidence: 99%

Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office

et al. 2010

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Historically, general practitioners provided first-contact care in the United States. Today, however, only 42 percent of the 354 million annual visits for acute care-treatment for newly arising health problems -are made to patients' personal physicians. The rest are made to emergency departments (28 percent), specialists (20 percent), or outpatient departments (7 percent). Although fewer than 5 percent of doctors are emergency physicians, they handle a quarter of all acute care encounters and more than half of such visits by the uninsured. Health reform provisions in the Patient Protection and Affordable Care Act that advance patient-centered medical homes and accountable care organizations are intended to improve access to acute care. The challenge for reform will be to succeed in the current, complex acute care landscape.

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Insurance Status and Access to Urgent Ambulatory Care Follow-up Appointments

Cited by 243 publications

References 14 publications

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

The effect of socioeconomic status on access to primary care: an audit study

Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office

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