Variation in outpatient emergency department utilization in Texas Medicaid_ a state-level framework for finding “superutilizers”

被引：10

作者：

Delcher C. ^{[1
]}

Yang C. ^{[2
]}

Ranka S. ^{[2
]}

Tyndall J.A. ^{[3
]}

Vogel B. ^{[1
]}

Shenkman E. ^{[1
]}

机构：

[1] Institute for Child Health Policy, Department of Health Outcomes and Policy, University of Florida, Gainesville, FL

[2] Department of Computer and Information Science and Engineering, University of Florida, Gainesville, FL

[3] Department of Emergency Medicine, University of Florida, Gainesville, FL

来源：

International Journal of Emergency Medicine | 2017年 / 10卷 / 1期

关键词：

Emergency department; Frequent users; Medicaid; Superutilizers;

D O I：

10.1186/s12245-017-0157-4

中图分类号：

学科分类号：

摘要：

Background: Very frequent outpatient emergency department (ED) use—so called “superutilization”—at the state level is not well-studied. To address this gap, we examined frequent ED utilization in the largest state Medicaid population to date. Methods: Using Texas Medicaid (the third largest in the USA) claims data, we examined the variability in expenditures, sociodemographics, comorbidities, and persistence across seven levels of ED utilization/year (i.e., 1, 2, 3–4, 5–6, 7–9, 10–14, and ≥ 15 visits). We classified visits into emergent and non-emergent categories using the most recent New York University algorithm. Results: Thirty-one percent (n = 346,651) of Texas Medicaid adult enrollees visited the ED at least once in 2014. Enrollees with ≥ 3 ED visits accounted for 8.5% of all adult patients, 60.4% of the total ED visits, and 62.1% of the total ED expenditures. Extremely frequent ED users (≥ 10 ED visits) represented < 1% of all users but accounted for 15.5% of all ED visits and 17.4% of the total ED costs. The proportions of ED visits classified as non-emergent or emergent, but primary care treatable varied little as ED visits increased. Overall, approximately 13% of ED visits were considered not preventable or avoidable. Conclusions: The Texas Medicaid population has a substantial burden of chronic disease with only modest increases in substance use and mental health diagnoses as annual visits increase. Understanding the characteristics that lead to frequent ED use is vital to developing strategies and Medicaid policy to reduce high utilization. © 2017, The Author(s).

引用

共 36 条

[1] Health, United States, 2015: with special feature on racial and ethnic health disparities [Internet], pp. 260-264, (2016)
[2] LaCalle E., Rabin E., Frequent users of emergency departments: the myths, the data, and the policy implications, Ann Emerg Med, 56, 1, pp. 42-48, (2010)
[3] Chen B.K., Cheng X., Bennett K., Hibbert J., Travel distances, socioeconomic characteristics, and health disparities in nonurgent and frequent use of hospital emergency departments in South Carolina: a population-based observational study, BMC Health Serv Res, 15, (2015)
[4] Weinick R.M., Burns R.M., Mehrotra A., Many emergency department visits could be managed at urgent care centers and retail clinics, Health Aff Proj Hope., 29, 9, pp. 1630-1636, (2010)
[5] Galarraga J.E., Pines J.M., Costs of ED episodes of care in the United States, Am J Emerg Med, 34, 3, pp. 357-365, (2016)
[6] Friedman A.B., Saloner B., Hsia R.Y., No place to call home—policies to reduce ED use in Medicaid, N Engl J Med, 372, 25, pp. 2382-2385, (2015)
[7] Billings J., Raven M.C., Dispelling an urban legend: frequent emergency department users have substantial burden of disease, Health Aff Proj Hope, 32, 12, pp. 2099-2108, (2013)
[8] Addressing growth in Medicaid spending: state options [Internet], (2016)
[9] Blumenthal D., Chernof B., Fulmer T., Lumpkin J., Selberg J., Caring for high-need, high-cost patients—an urgent priority, N Engl J Med, 375, 10, pp. 909-911, (2016)
[10] Buhumaid R., Riley J., Sattarian M., Bregman B., Blanchard J., Characteristics of frequent users of the emergency department with psychiatric conditions, J Health Care Poor Underserved, 26, 3, pp. 941-950, (2015)

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