What Drives Frequent Emergency Department Use in an Integrated Health System? National Data From the Veterans Health Administration

Doran, Kelly M.; Raven, Maria C.; Rosenheck, Robert A.

doi:10.1016/j.annemergmed.2013.02.016

Cited by 138 publications

(164 citation statements)

References 41 publications

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“…Previous studies also suggest that simply focusing on PCP access alone will not lead to lower ED utilization via shifting patients to outpatient preventive care. 12,23 Instead, our findings suggest that interventions should be focused on targeting multiple ED users and addressing the particular needs of this subpopulation. The goal is therefore not necessarily to reduce ED use per se, but rather to promote appropriate use of health care resources and better coordinated care, including EDs as part of the care continuum.…”

Section: Original Research and Contributionsmentioning

confidence: 80%

“…Similar findings have been observed in other health care delivery settings in which frequent users of the ED were also frequent users of other health care services, including outpatient care. 19,[21][22][23] This is likely to reflect that fact that the ED provides unique care that other health care venues do not typically offer, such as continuous care without restricted hours of operation. Indeed, the ED may be the most appropriate mode of care for certain disease states and patient subpopulations.…”

Section: Original Research and Contributionsmentioning

confidence: 99%

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Patterns of Multiple Emergency Department Visits: Do Primary Care Physicians Matter?

Maeng

Hao

Bulger

2017

TPJ

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Context: Overutilization and overreliance on Emergency Departments (EDs) as a usual source of care can lead to unnecessarily high costs and undesirable consequences, such as a gap in care coordination and inadequate provision of preventive care.Objective: To identify factors associated with multiple ED visits by patients, in particular, the impact of primary care physicians (PCPs) on their patients' multiple ED visit rates.Design: Geisinger Health Plan claims data among adult patients who averaged more than 1 ED visit within a 12-month period between 2013 and 2014 were obtained (N = 20,351).Main Outcome Measures: Rate of ED visits. Three linear regression models using patient characteristics and utilization patterns as covariates along with PCP fixed effects were estimated to explain the variation in the multiple ED visit rates.Results: Multiple ED visits were significantly associated with younger age (18-39 years), having Medicaid insurance, and greater comorbidity. Higher rates of physician office visits and inpatient admissions were also associated with higher rates of multiple ED visits. Accounting for PCP characteristics only marginally improved the explained variation (R 2 increased from 0.14 to 0.16).Conclusions: Multiple ED visit patterns are likely driven by patients' health conditions and care needs rather than by their PCPs. Multiple ED visits also appear to be complementary, rather than substitutionary, to PCP visits, suggesting that PCP-focused interventions aimed at reducing ED use are unlikely to have a major impact.

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Section: Original Research and Contributionsmentioning

confidence: 80%

Section: Original Research and Contributionsmentioning

confidence: 99%

Patterns of Multiple Emergency Department Visits: Do Primary Care Physicians Matter?

Maeng

Hao

Bulger

2017

TPJ

View full text Add to dashboard Cite

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“…In general, research has found that people who are homeless tend to be disproportionately represented among ED patients, and particularly among the most frequent users of EDs, [14][15][16][17] in large part due to their high burden of chronic medical and behavioral health problems. Mental health and substance use diagnoses remained consistent in their prevalence as primary ED diagnoses among those with a secondary diagnosis of homelessness or inadequate housing before and after Hurricane Sandy.…”

Section: Ed Visits For Homelessness In Nyc After Hurricane Sandymentioning

confidence: 99%

Emergency Department Visits for Homelessness or Inadequate Housing in New York City before and after Hurricane Sandy

et al. 2016

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“…Multiple prior studies have documented extensive use of emergency department and inpatient care by homeless individuals. [39][40][41][42] For example, Tsai and colleagues found that homeless Veterans had four times the odds of using EDs than non-homeless Veterans. 40 However, Gabrielian and colleagues noted that while HUD-VASH enrolled Veterans had initial significant increases in primary care and specialty utilization upon enrollment, HUD-VASH Veterans and low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization compared with non-homeless peers over time.…”

Section: Discussionmentioning

confidence: 99%

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

et al. 2016

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BACKGROUND: Veterans with evidence of homelessness have high rates of mental health and substance abuse disorders, but chronic medical conditions such as diabetes are also prevalent. OBJECTIVE: We aimed to determine the impact of homelessness on glycemic control in patients with type 2 diabetes mellitus. DESIGN: Longitudinal analysis of a retrospective cohort. SUBJECTS: A national cohort of 1,263,906 Veterans with type 2 diabetes. Subjects with evidence of homelessness were identified using a combination of diagnostic and administrative codes. MAIN MEASURES: Odds for poor glycemic control using hemoglobin A1C (HbA1C) cutoff values of 8 % and 9 %. Homeless defined as a score based on the number of indicator variables for homelessness within a veterans chart. KEY RESULTS: Veterans with evidence of homelessness had a significantly greater annual mean HbA1C ≥ 8 (32.6 % vs. 20.43 %) and HbA1C ≥ 9 (21.4 % vs. 9.9 %), tended to be younger (58 vs. 67 years), were more likely to be non-Hispanic black (39.1 %), divorced (43 %) or never married (34 %), to be urban dwelling (88.8 %), and to have comorbid substance abuse (46.7 %), depression (42.3 %), psychoses (39.7 %), liver disease (18.8 %), and fluid/ electrolyte disorders (20.4 %), relative to non-homeless veterans (all p < 0.0001). Homelessness was modeled as an ordinal variable that scored the number of times a homelessness indicator was found in the Veterans medical record. We observed a significant interaction between homelessness and race/ethnicity on the odds of poor glycemic control. Homelessness, across all racial-ethnic groups, was associated with increased odds of uncontrolled diabetes at a cut-point of 8 % and 9 % for hemoglobin A1C ; however, the magnitude of the association was greater in non-Hispanic whites [8 %, OR 1.55 (1.47;1.63 CONCLUSIONS: Homelessness is a significant risk factor for uncontrolled diabetes in Veterans, especially among non-Hispanic white and Hispanic patients. While efforts to engage homeless patients in primary care services have had some success in recent years, these data suggest that broader efforts targeting management of diabetes and other chronic medical conditions remain warranted.

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What Drives Frequent Emergency Department Use in an Integrated Health System? National Data From the Veterans Health Administration

Cited by 138 publications

References 41 publications

Patterns of Multiple Emergency Department Visits: Do Primary Care Physicians Matter?

Patterns of Multiple Emergency Department Visits: Do Primary Care Physicians Matter?

Emergency Department Visits for Homelessness or Inadequate Housing in New York City before and after Hurricane Sandy

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

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