2 These developments have led to the current ED capacity crisis, requiring evidence-based initiatives to reduce nonemergent ED visits. 4, 5 Since 2003, crowding has been aggravated by a new role served by EDs, as intermediate care zones (Observational Units) to preempt medically unnecessary inpatient admissions. 3 ED crowding steadily increased since 1997 through 2007, partly due to ED closures exceeding new EDs opened by 23.7%, while ED visit volumes increased 30%. In 2011, uninsured patients accounted for 16% of 131 million ED visits, nationwide. 1 - 3 However, EDs also present financial and medical resource challenges, being mandated to provide care to all patients under the Emergency Medical Treatment and Active Labor Act. About 14.7% of ED visits end in inpatient admission. The observed reductions in overall ED visit rates, particularly low-severity visits highest reductions observed among high-users and the top quartile of occasional users and the pattern of changes in emergency severity support a positive impact of the primary care intervention.Įmergency departments (EDs) are mission-critical for hospitals, and a key source of inpatient admissions, accounting for 50% of all inpatient admissions nationally in 2011. Pre- and post-intervention sample demographics and comorbidities were similar. Upon classifying preintervention high-users by emergency severity, postintervention mean ESI increased 24.5% among the lowest ESI quartile, and decreased 12.2% among the top quartile. Subgroup analysis of medically uninsured high-users showed similar results. Visit rates of the top quartile of occasional users also declined. Postintervention, the visit rates of new high-users were lower (lowest and top quartile rates, 0.6 and 3.23) than preintervention high-users’ rates in the preintervention period. High-users’ mean annual visit rates were 5.43 (top quartile) and 0.94 (bottom quartile) preintervention, versus 3.21 and 1.11, respectively, for returning high-users, postintervention (all P <. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. We compared pre- versus post-mean annual visit rates and discharge emergency severity index (ESI triage and resource use–based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) and occasional users. We studied adult ED visits during August 16, 2009-Aug(preintervention) and August 16, 2011-Aug(postintervention). This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. Reducing avoidable emergency department (ED) visits is an important health system goal.
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