Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006–2010: an observational studyReportar como inadecuado




Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006–2010: an observational study - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

International Journal for Equity in Health

, 14:30

First Online: 21 March 2015Received: 15 August 2014Accepted: 26 February 2015DOI: 10.1186-s12939-015-0158-y

Cite this article as: Chen, B.K., Hibbert, J., Cheng, X. et al. Int J Equity Health 2015 14: 30. doi:10.1186-s12939-015-0158-y

Abstract

IntroductionUse of the hospital emergency department ED for medical conditions not likely to require immediate treatment is a controversial topic. It has been faulted for ED overcrowding, increased expenditures, and decreased quality of care. On the other hand, such avoidable ED utilization may be a manifestation of barriers to primary care access.

MethodsA random 10% subsample of all ED visits with unmasked variables, or approximately 7.2% of all ED visits in California between 2006 and 2010 are used in the analysis. Using panel data methods, we employ linear probability and fractional probit models with hospital fixed effects to analyze the associations between avoidable ED utilization in California and observable patient characteristics. We also test whether shorter estimated road distances to the hospital ED are correlated with non-urgent ED utilization, as defined by the New York University ED Algorithm. We then investigate whether proximity of a Federally Qualified Health Center FQHC is correlated with reductions in non-urgent ED utilization among Medicaid patients.

ResultsWe find that relative to the reference group of adults aged 35–64, younger patients generally have higher scores for non-urgent conditions and lower scores for urgent conditions. However, elderly patients ≥65 use the ED for conditions more likely to be urgent. Relative to male and white patients, respectively, female patients and all identified racial and ethnic minorities use the ED for conditions more likely to be non-urgent. Patients with non-commercial insurance coverage also use the ED for conditions more likely to be non-urgent. Medicare and Medicaid patients who live closer to the hospital ED have higher probability scores for non-emergent visits. However, among Medicaid enrollees, those who live in zip codes with an FQHC within 0.5 mile of the zip code population centroid visit the ED for medical conditions less likely to be non-emergent.

ConclusionsThese patterns of ED utilization point to potential barriers to care among historically vulnerable groups, observable even when using rough estimates of travel distances and avoidable ED utilization.

KeywordsAvoidable emergency department utilization NYU ED Algorithm Barriers to primary care Medicaid Vulnerable populations Health disparities AbbreviationsEDEmergency Department

FQHCFederally Qualified Health Center

NENon-Emergent

NEPCTNon-Emergent or Primary Care Treatable

NYU ED AlgorithmNew York University Emergency Department Algorithm

PCPPrimary Care Preventable

PCTPrimary Care Treatable

VAVeterans Affairs

Electronic supplementary materialThe online version of this article doi:10.1186-s12939-015-0158-y contains supplementary material, which is available to authorized users.

Download fulltext PDF



Autor: Brian K Chen - James Hibbert - Xi Cheng - Kevin Bennett

Fuente: https://link.springer.com/







Documentos relacionados