Characteristics of Primary Care Practices Affect Patients' Emergency Department Use

• Published in: Academic emergency medicine 2003-05, Vol.10 (5), p.512-512
• Main Author: Lowe, R. A
• Format: Article
• Language: English
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/aemj.10.5.512-a

OBJECTIVE: Much attention has been focused on decreasing emergency department (ED) use. Most previous research has studied characteristics of patients seeking ED care, finding that poor, under-insured, and non-White patients are more likely to use the ED, but these studies have not led to successful policy changes. We sought to measure the association between characteristics of primary care practices serving Medicaid patients and ED utilization by these patients. METHODS: Cohort study of 57,850 patients under age 65 who were enrolled in a single Medicaid HMO in Southeastern Pennsylvania from August 1, 1998 to July 31, 1999 and received care in 353 primary care practice sites. Predictor variables were practice site characteristics, ascertained by data collection at each site. The outcome measure was the rate of ED use, adjusted for patient characteristics, as obtained from HMO administrative data. RESULTS: On average, patients made 0.80 visits to the ED per person per year. ED use was 2% lower for every hour after 5 PM that a practice was open on weekdays (RR 0.98, 95% CI 0.97-0.99). Medicaid patients assigned to practices with a higher proportion of Medicaid patients had greater ED utilization rates. A higher ratio of the number of active patients per clinician-hour of practice time was also associated with more ED use. Equipment for the care of asthmatic patients was associated with ED use rates, but the direction of the association depended on the type of equipment. Rates were higher when nurse practitioners and physician assistants were part of the treatment team. CONCLUSION: Primary care practices that are open more evening hours have lower ED use by their Medicaid patients. Practices that are over-stressed, as measured by higher patient load and higher proportion of Medicaid patients, have greater ED use. Some of these associations suggest interventions that should be studied for their ability to reduce ED use.