Lindsay Allen1, Janet R Cummings2, Jason M Hockenberry3. 1. School of Public Health, West Virginia University, Morgantown, West Virginia, USA. 2. Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. 3. Yale School of Public Health, New Haven, Connecticut, USA.
Abstract
OBJECTIVE: To estimate the impact of urgent care centers on emergency department (ED) use. DATA SOURCES: Secondary data from a novel urgent care center database, linked to the Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) from six states. STUDY DESIGN: We used a difference-in-differences design to examine ZIP code-level changes in the acuity mix of emergency department visits when local urgent care centers were open versus closed. ZIP codes with no urgent care centers served as a control group. We tested for differential impacts of urgent care centers according to ED wait time and patient insurance status. DATA COLLECTION/EXTRACTION METHODS: Urgent care center daily operating times were determined via the urgent care center database. Emergency department visit acuity was assessed by applying the NYU ED algorithm to the SEDD data. Urgent care locations and nearby emergency department encounters were linked via zip code. PRINCIPAL FINDINGS: We found that having an open urgent care center in a ZIP code reduced the total number of ED visits by residents in that ZIP code by 17.2% (P < 0.05), due largely to decreases in visits for less emergent conditions. This effect was concentrated among visits to EDs with the longest wait times. We found that urgent care centers reduced the total number of uninsured and Medicaid visits to the ED by 21% (P < 0.05) and 29.1% (P < 0.05), respectively. CONCLUSIONS: During the hours they are open, urgent care centers appear to be treating patients who otherwise would have visited the ED. This suggests that urgent care centers have the potential to reduce health care expenditures, though questions remain about their net cost impact. Future work should assess whether urgent care centers can improve health care access among populations that often experience barriers to receiving timely care.
OBJECTIVE: To estimate the impact of urgent care centers on emergency department (ED) use. DATA SOURCES: Secondary data from a novel urgent care center database, linked to the Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) from six states. STUDY DESIGN: We used a difference-in-differences design to examine ZIP code-level changes in the acuity mix of emergency department visits when local urgent care centers were open versus closed. ZIP codes with no urgent care centers served as a control group. We tested for differential impacts of urgent care centers according to ED wait time and patient insurance status. DATA COLLECTION/EXTRACTION METHODS: Urgent care center daily operating times were determined via the urgent care center database. Emergency department visit acuity was assessed by applying the NYU ED algorithm to the SEDD data. Urgent care locations and nearby emergency department encounters were linked via zip code. PRINCIPAL FINDINGS: We found that having an open urgent care center in a ZIP code reduced the total number of ED visits by residents in that ZIP code by 17.2% (P < 0.05), due largely to decreases in visits for less emergent conditions. This effect was concentrated among visits to EDs with the longest wait times. We found that urgent care centers reduced the total number of uninsured and Medicaid visits to the ED by 21% (P < 0.05) and 29.1% (P < 0.05), respectively. CONCLUSIONS: During the hours they are open, urgent care centers appear to be treating patients who otherwise would have visited the ED. This suggests that urgent care centers have the potential to reduce health care expenditures, though questions remain about their net cost impact. Future work should assess whether urgent care centers can improve health care access among populations that often experience barriers to receiving timely care.
Authors: Grant Martsolf; Kathryn R Fingar; Rosanna Coffey; Ryan Kandrack; Tom Charland; Christine Eibner; Anne Elixhauser; Claudia Steiner; Ateev Mehrotra Journal: Ann Emerg Med Date: 2016-11-10 Impact factor: 5.721