Travel distances, socioeconomic characteristics, and health disparities in nonurgent and frequent use of Hospital Emergency Departments in South Carolina: a population-based observational study

BMC Health Services Research, May 2015

Background Nonurgent use of hospital emergency departments (ED) is a controversial topic. It is thought to increase healthcare costs and reduce quality, but is also considered a symptom of unequal access to health care. In this article, we investigate whether convenience (as proxied by travel distances to the hospital ED and to the closest federally qualified health center) is associated with nonurgent ED use, and whether evidence of health disparities exist in the way vulnerable populations use the hospital ED for medical care in South Carolina. Methods Our data includes 6,592,501 ED visits in South Carolina between 2005 and 2010 from the South Carolina Budget Control Board and Office of Research and Statistics. All ED visits by South Carolina residents with unmasked variables and nonmissing urgency measures, or approximately 76 % of all ED visits, are used in the analysis. We perform multivariable linear regressions to estimate correlations between (1) travel distances and observable sociodemographic characteristics and (2) measures of nonurgent ED use or frequent nonurgent ED use, as defined by the New York University ED Algorithm. Results Patients with commercial private insurance, self-pay patients, and patients with other payment sources have lower measures of nonurgent ED use the further away the ED facility is from the patients’ home address. Vulnerable populations, particularly African American and Medicaid patients, have higher measures of nonurgent ED scores, and are more frequent users of the ED for both nonurgent and urgent reasons in South Carolina. At the same time, African Americans visit the hospital ED for medical conditions with higher primary care-preventable scores. Conclusions Contrary to popular belief, convenient access (in terms of travel distances) to hospital ED is correlated with less-urgent ED use among privately insured patients and self-pay patients in South Carolina, but not publicly insured patients. Unequal access to primary care appears to exist, as suggested by African American patients’ use of the hospital ED for primary care-treatable conditions while experiencing more frequent and more severe primary care-preventable conditions.

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Travel distances, socioeconomic characteristics, and health disparities in nonurgent and frequent use of Hospital Emergency Departments in South Carolina: a population-based observational study

Chen et al. BMC Health Services Research Travel distances, socioeconomic characteristics, and health disparities in nonurgent and frequent use of Hospital Emergency Departments in South Carolina: a population-based observational study Brian K. Chen 0 Xi Cheng 0 Kevin Bennett 1 James Hibbert 0 0 Arnold School of Public Health, University of South Carolina , 915 Greene Street Suite 354, Columbia, South Carolina 29208 , USA 1 School of Medicine, University of South Carolina , Columbia, South Carolina , USA Background: Nonurgent use of hospital emergency departments (ED) is a controversial topic. It is thought to increase healthcare costs and reduce quality, but is also considered a symptom of unequal access to health care. In this article, we investigate whether convenience (as proxied by travel distances to the hospital ED and to the closest federally qualified health center) is associated with nonurgent ED use, and whether evidence of health disparities exist in the way vulnerable populations use the hospital ED for medical care in South Carolina. Methods: Our data includes 6,592,501 ED visits in South Carolina between 2005 and 2010 from the South Carolina Budget Control Board and Office of Research and Statistics. All ED visits by South Carolina residents with unmasked variables and nonmissing urgency measures, or approximately 76 % of all ED visits, are used in the analysis. We perform multivariable linear regressions to estimate correlations between (1) travel distances and observable sociodemographic characteristics and (2) measures of nonurgent ED use or frequent nonurgent ED use, as defined by the New York University ED Algorithm. Results: Patients with commercial private insurance, self-pay patients, and patients with other payment sources have lower measures of nonurgent ED use the further away the ED facility is from the patients' home address. Vulnerable populations, particularly African American and Medicaid patients, have higher measures of nonurgent ED scores, and are more frequent users of the ED for both nonurgent and urgent reasons in South Carolina. At the same time, African Americans visit the hospital ED for medical conditions with higher primary care-preventable scores. Conclusions: Contrary to popular belief, convenient access (in terms of travel distances) to hospital ED is correlated with less-urgent ED use among privately insured patients and self-pay patients in South Carolina, but not publicly insured patients. Unequal access to primary care appears to exist, as suggested by African American patients' use of the hospital ED for primary care-treatable conditions while experiencing more frequent and more severe primary care-preventable conditions. Nonurgent use; Emergency department; Primary care access; Health disparities - Background Visiting hospital emergency departments (ED) for nonurgent medical conditions is a controversial topic. In the United States, high-end estimates consider approximately 56 % of more than 120 million annual visits to the hospital ED to be potentially avoidable, costing an estimated $38 billion in additional healthcare expenditures [1]. Conservative estimates place nonurgent ED use at 8 % of annual ED visits, by patients of all payer and age groups, and contrary to popular belief, even by patients with a usual place of care [2]. In this article, we separate use of the hospital ED into four broad categories: care received for medical conditions not requiring treatment within 12 h, care that could have been safely and effectively provided in a primary care setting, care for conditions that could have been prevented with timely and appropriate primary care, or care requiring unavoidable emergency treatment [3]. We consider the first two types of ED use to be nonurgent. Although opinions differ, some believe that such use of the ED may contribute to negative consequences such as ED overcrowding [4], increased lengths of stay [5-7], early departures of patients requiring care [8], and ED care rationing [9, 10]. Moreover, the episodic nature of ED care makes it inappropriate as a “medical home” for vulnerable patients requiring coordination of care. However, many consider nonurgent use of the hospital ED as a symptom of barriers to primary care access for vulnerable populations [11-14]. Despite substantial controversy surrounding nonurgent ED use, there is surprisingly little population-based research on the observable factors associated with nonurgent (as opposed to frequent) ED use. Many of the existing studies drew their samples from a single institution, had samples smaller than 500 individuals, or applied only bivariate or descriptive statistics [15]. To supplement and extend the results of these studies to a population level, we used all available in-state ED visits from South Carolina to assess correlations between observable factors (patient socioeconomic characteristics as well as travel distances) and measures of ED visit urgency. Our overarchi (...truncated)


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Brian Chen, Xi Cheng, Kevin Bennett, James Hibbert. Travel distances, socioeconomic characteristics, and health disparities in nonurgent and frequent use of Hospital Emergency Departments in South Carolina: a population-based observational study, BMC Health Services Research, 2015, pp. 203, 15, DOI: 10.1186/s12913-015-0864-6