Trends and Characteristics of US Emergency Department Visits, 1997-2007

Abstract

MERGENCY DEPARTMENTS (EDS) are unique portals for health care in the United States because services are provided to all persons regardless of insurance or ability to pay. 1 As such, the Institute of Medicine has labeled EDs as "the Safety Net of the Safety Net . . . the provider of last resort for millions of patients who are uninsured or lack adequate access to care from community providers." 2 Among all EDs, the Centers for Disease Control and Prevention (CDC) further identified a subset as safety-net EDs because these EDs provide a disproportionate share of services to Medicaid and uninsured persons. Specifically, safety-net EDs are facilities that provide more than 30% of total ED visits to persons with Medicaid, more than 30% of total ED visits to uninsured individuals, or a combined Medicaid and uninsured patient population greater than 40%. 3 Since the 1990s, visits to US EDs have steadily increased and the total number of EDs has declined. 4,5 Meanwhile, the number of uninsured persons has increased from 38.8 million in 1999 to 46.3 million in 2008 and Medicaid enrollment has increased from 28.5 million in 1999 to 42.6 million in 2008. 6 Previous research shows that privately insured persons accounted for most of the increase in ED visits be-tween 1996 and 2001. 7 However, recent studies suggest an increasing number of uninsured and underinsured persons contributing to ED visits. [8][9][10] Patients who cannot obtain timely access to primary care often make frequent ED visits and often present with more severe illness and complications. 11,12 This study examines changes in ED visit rates in the United States between 1997 and 2007, detailing differences between sociodemographic sub-groups. To evaluate the hypothesis that EDs are serving in a safety-net role for an increasing segment of the US population, we specifically examined trends in ED visit rates according to insur-See also p 679.

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

“…7 Furthermore, other studies have demonstrated that increased outpatient contact (e.g., PN outreach) may be associated with more readmissions, particularly among younger low SES patients, 46,47 suggesting that such patients may need more finely targeted, and possibly more intensive, outpatient care. Additionally, younger, low SES patients have exhibited high utilization of hospital-based care, 48,49 possibly reflecting an underlying belief that hospital-based care is easier to access and of higher quality. 50 Because PNs were hospital-based, their supportive work may have unintentionally encouraged younger patients to return to the hospital for medical care.…”

The effect of working on-call on stress physiology and sleep: A systematic review

“…It is possible that this resulted in more time on-call from home, and increased transit time between the hospital and home. It may also be impacted by an increased number of people visiting emergency departments [66,67] and therefore a likely increase in the number of calls. If call patterns or working arrangements change to increase call frequency or the proportion of time that workers are oncall, it is likely that sleep disruptions will also increase.…”

Emergency Department Visits after Kidney Transplantation

“…To some degree, this suggests that the ED is not the initial point of care in the immediate discharge period for the majority of transplant recipients but does continue to be a source of care over time and notably, includes common admissions to hospitals other than the transplant hospital with extended time after discharge. To place findings in perspective in other settings, Tang et al (26) showed that rates of ED use in the general population increased from 35 to 39 visits per 100 patient-years between 1997 and 2007, with increased rates among underserved Medicaid patients. A national study of Medicare patients receiving surgery (including percutaneous coronary intervention, hip fracture repair, and coronary artery bypass grafting) reported a 30-day ED visit rate of 17% (14).…”