Potentially Avoidable Emergency Department Use: When Policy Expects Patients to be Physicians

Jaffe, Todd A.; Kocher, Keith E.; Ghaferi, Amir A.

doi:10.1016/j.annemergmed.2018.05.019

Cited by 15 publications

(12 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even with a more efficient system of out-of-hours consultations or UCCs, we do not know whether this anxiety (or urgency felt) did not lead the patient to the ED anyway. All these results suggest that educating the public about unscheduled care offer as well as public policies (whose goal would be to develop and promote alternatives to ED) could be enhanced 77…”

Section: Discussionmentioning

confidence: 95%

Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France

et al. 2019

View full text Add to dashboard Cite

BackgroundInappropriate visits to emergency departments (EDs) could represent from 20% to 40% of all visits. Inappropriate use is a burden on healthcare costs and increases the risk of ED overcrowding. The aim of this study was to explore socioeconomic and geographical determinants of inappropriate ED use in France.MethodThe French Emergency Survey was a nationwide cross-sectional survey conducted on June 11 2013, simultaneously in all EDs in France and covered characteristics of patients, EDs and counties. The survey included 48 711 patient questionnaires and 734 ED questionnaires. We focused on adult patients (≥15 years old). The appropriateness of the ED visit was assessed by three measures: caring physician appreciation of appropriateness (numeric scale), caring physician appreciation of whether or not the patient could have been managed by a general practitioner and ED resource utilisation. Descriptive statistics and multilevel logistic regression were used to examine determinants of inappropriate ED use, estimating adjusted ORs and 95% CIs.ResultsAmong the 29 407 patients in our sample, depending on the measuring method, 13.5% to 27.4% ED visits were considered inappropriate. Regardless of the measure method used, likelihood of inappropriate use decreased with older age and distance from home to the ED >10 km. Not having a private supplementary health insurance, having universal supplementary health coverage and symptoms being several days old increased the likelihood of inappropriate use. Likelihood of inappropriate use was not associated with county medical density.ConclusionInappropriate ED use appeared associated with socioeconomic vulnerability (such as not having supplementary health coverage or having universal coverage) but not with geographical characteristics. It makes us question the appropriateness of the concept of inappropriate ED use as it does not consider the distress experienced by the patient, and segments of society seem to have few other choices to access healthcare than the ED.

show abstract

Section: Discussionmentioning

confidence: 95%

Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France

et al. 2019

View full text Add to dashboard Cite

show abstract

“…results Appropriate ED use based on professional criteria was 33.5%, which increased to 63.1% when patient criteria were added. The AUC, which combines both professional and patient criteria, was high (0.85).…”

Section: Statistical Analysesmentioning

confidence: 94%

“…22 Most researchers agree that it should not be the responsibility of patients to decide correctly whether a condition is an emergency medical condition or where to seek professional care. 33 In response to these concerns, the PLS has been applied to most health Open access plans in the USA. This study sought to find a common definition of appropriate ED visits by considering urgency, severity, complexity, intensity and patient need in ED visit.…”

Section: Multivariate Analysesmentioning

confidence: 99%

Appropriateness of emergency care use: a retrospective observational study based on professional versus patients’ perspectives in Taiwan

Lin

Lee²

2020

BMJ Open

View full text Add to dashboard Cite

ObjectiveThe objectives of this study are to refine the measurement of appropriate emergency department (ED) use and to provide a natural observation of appropriate ED use rates based on professional versus patient perspectives.SettingTaiwan has a population of 23 million, with one single-payer universal health insurance scheme. Taiwan has no limitations on ED use, and a low barrier to ED use may be a surrogate for natural observation of users’ perspectives in ED use.ParticipantsIn 7 years, there were 1 835 860 ED visits from one million random samples of the National Health Insurance Database.MeasuresAppropriate ED use was determined according to professional standards, measured by the modified Billings New York University Emergency Department (NYU-ED) algorithm, and further analysed after the addition of prudent patient standards, measured by explicit process-based and outcome-based criteria.Statistical analysesThe area under the receiver operating characteristic curve (AUC) was used to reflect the performance of appropriate ED use measures, and sensitivity analyses were conducted using different thresholds to determine the appropriateness of ED use. The generalised estimating equation model was used to measure the associations between appropriate ED use based on process and outcome criteria and covariates including sex, age, occupation, health status, place of residence, medical resources area, date and income level.ResultsAppropriate ED use based on professional criteria was 33.5%, which increased to 63.1% when patient criteria were added. The AUC, which combines both professional and patient criteria, was high (0.85).ConclusionsThe appropriate ED use rate nearly doubled when patient criteria were added to professional criteria. Explicit process-based and outcome-based criteria may be used as a supplementary measure to the implicit modified Billings NYU-ED algorithm when determining appropriate ED use.

show abstract

“…Although policies have been crafted to realize these proposed benefits, some efforts have been controversial, especially those that penalize patients retrospectively for seeking ED care for conditions later deemed to not be actual emergencies 5 . Furthermore, it is unclear whether or not the introduction of UCs in proximity to EDs is associated with decreasing rates of low‐acuity ED visits 6,7 .…”

Section: Variables Seven‐state Sample Low‐acuity Users (N = 1986) Prmentioning

confidence: 99%

Differences Between Emergency Department and Urgent Care Users for Low‐acuity Health Needs: A Public Opinion Analysis

Scott

Findling

Huskamp

et al. 2020

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Potentially Avoidable Emergency Department Use: When Policy Expects Patients to be Physicians

Cited by 15 publications

References 3 publications

Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France

Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France

Appropriateness of emergency care use: a retrospective observational study based on professional versus patients’ perspectives in Taiwan

Differences Between Emergency Department and Urgent Care Users for Low‐acuity Health Needs: A Public Opinion Analysis

Contact Info

Product

Resources

About