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Ambulatory care, insurance, and avoidable emergency department utilization in North Carolina
Journal article   Open access   Peer reviewed

Ambulatory care, insurance, and avoidable emergency department utilization in North Carolina

Carlene A. Mayfield, Marco Geraci, Brisa Urquieta de Hernandez, Michael Dulin, Jan M. Eberth and Anwar T. Merchant
The American journal of emergency medicine, v 46
01 Aug 2021
DOI: https://doi.org/10.1016/j.ajem.2020.07.034
PMID: 33071099
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.ajem.2020.07.034View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

Emergency Medicine Life Sciences & Biomedicine Science & Technology
Objective: To examine whether and how avoidable emergency department (ED) utilization is associated with ambulatory or primary care (APC) utilization, insurance, and interaction effects. Design and sample: A cross-sectional analysis of electronic health records from 70,870 adults residing in Mecklenburg County, North Carolina, who visited an ED within a large integrated healthcare system in 2017. Methods: APC utilization was measured as total visits, categorized as: 0, 1, and > 1. Insurance was defined as the method of payment for the ED visit as: Medicaid, Medicare, private, or uninsured. Avoidable ED utilization was quantified as a score (aED), calculated as the sum of New York University Algorithm probabilities multiplied by 100. Quantile regression models were used to predict the 25th, 50th, 75th, 95th, and 99th percentiles of avoidable ED scores with APC visits and insurance as predictors (Model 1) and with an interaction term (Model 2). Results: Having >1 APC visit was negatively associated with aED at the lower percentiles and positively associated at higher percentiles. A higher aED was associated with having Medicaid insurance and a lower aED was associated with having private insurance, compared to being uninsured. In stratified models, having >1 APC visit was negatively associated with aED at the 25th percentile for the uninsured and privately insured, but positively associated with aED at higher percentiles among the uninsured, Medicaid-insured, and privately insured. Conclusions: The association between APC utilization and avoidable ED utilization varied based on segments of the distribution of ED score and differed significantly by insurance type. (c) 2020 Elsevier Inc. All rights reserved.

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2 citations in Scopus

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Collaboration types
Domestic collaboration
Web of Science research areas
Emergency Medicine
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