Daniel D Maeng1, Jing Hao2, John B Bulger3. 1. Primary Investigator and Assistant Professor for the Department of Epidemiology and Health Services Research, Geisinger Health System in Danville, PA. ddmaeng@geisinger.edu. 2. Assistant Professor for the Department of Epidemiology and Health Services Research, Geisinger Health System in Danville, PA. jhao@geisinger.edu. 3. Chief Medical Officer for the Geisinger Health Plan, Geisinger Health System in Danville, PA. jbulger@geisinger.edu.
Abstract
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 (R2 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.
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 (R2 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.
Authors: Kathryn Hodwitz; Niels Thakkar; Susan E Schultz; Liisa Jaakkimainen; Daniel Faulkner; Wendy Yen Journal: BMJ Open Date: 2019-06-11 Impact factor: 2.692
Authors: Zhaowei She; Anne H Gaglioti; Peter Baltrus; Chaohua Li; Miranda A Moore; Lilly C Immergluck; Arthi Rao; Turgay Ayer Journal: J Prim Care Community Health Date: 2020 Jan-Dec