20 Oct Nearly Half of All US Medical Care is Delivered by Emergency Departments

MedicalResearch.com Interview with:

Dr. Marcozzi

David Marcozzi, MD, MHS-CL, FACEP
Associate Professor
Director of Population Health
Department of Emergency Medicine
Adjunct Associate Professor
Co-Director of the Program in Health Disparities and Population Health
Department of Epidemiology and Public Health
University of Maryland School of Medicine
Assistant Chief Medical Officer for Acute Care
University of Maryland Medical Center

MedicalResearch.com: What is the background for this study?

Response: Nearly half of all US medical care is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine (UMSOM). And in recent years, the percentage of care delivered by emergency departments has grown. The study highlights what many experts argue is a major flaw in American health care: the use of emergency care in non-urgent cases, where clinics and doctor’s offices would be more appropriate.

“I was shocked by this result. This really helps us understand health care in this country. This research underscores the fact that emergency departments are critical to our nation’s healthcare delivery system, particularly for Americans who have no access to care.” said David Marcozzi, MD, MHS-CL, FACEP, an associate professor in the UMSOM Department of Emergency Medicine, and co-director of the UMSOM Program in Health Disparities and Population Health. “Patients seek care delivered in emergency departments for many reasons, and we need to face this fact this is a significant segment of healthcare and actually it may be delivering the type of care that individuals want and need—24/7, 365 days.”  Although he now focuses on population health and hospital throughput, Dr. Marcozzi is an emergency room doctor himself, and works one or two days a week in the University of Maryland Medical Center emergency department, treating patients.

MedicalResearch.com: What are the main findings?

Response: This is the first study to quantify the contribution of emergency departments to the delivery of health care in the U.S based on the CDC National Hospital Ambulatory Medical Care Survey. The paper appears in the latest issue of International Journal for Health Services.

For this study, Dr. Marcozzi and his colleagues examined publicly available data from several national healthcare databases, which covered all 50 states and the District of Columbia. They studied the period between 1996 and 2010.

For 2010, the most recent your study, the study found that there were nearly hundred and 30 million emergency department visits, compared with almost 101 million outpatient visits and nearly 39 million inpatient visits. Inpatient visits typically involve a hospital stay, but are planned ahead, as opposed to emergency room visits, which are generally at least somewhat unexpected.

Over the 14 year period of the study, more than 3.5 billion health care contacts — emergency room visits, outpatient visits, and hospital admissions took place. Over that time, ED visits increased by nearly 44 percent. Outpatient visits accounted for nearly 38 percent of contacts. Inpatient care accounted for almost 15 percent of visits.

Certain groups were significantly more likely to use the emergency room as their method of healthcare. African-American patients were significantly more likely to have emergency room visits than patients in other racial groups; patients in the “other” insurance category, which includes those without any type of insurance, were significantly more likely to have emergency room visits than any other group. And patients living in the South were significantly more likely to have emergency room visits than patients living in other areas of the country.

African-American patients used of emergency room care at a higher rate than other groups. In 2010, this group used the emergency room almost 54 percent of the time. The rate was even higher for urban African-American patients, who used emergency room care 59 percent of the time that year. Emergency department use rates in south and west were 54 percent and 56 percent, respectively. In the northeast, use was much lower, 39 percent of all visits.

Certain groups accounted for increasing percentages of overall emergency room use: African-Americans, Medicare and Medicaid beneficiaries, residents of the south and west, and women. Dr. Marcozzi says that these findings point to increasing use by vulnerable populations, which is no surprise since socioeconomic and racial inequality creates barriers to the use health care.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: The use of emergency care resources for non-emergency cases has been controversial. Some experts argue that emergency departments are covering for deficiencies in inpatient and outpatient resources, and for a lack of effective prevention strategies. They argue that emergency room use should be reduced.

Dr. Marcozzi says this is unlikely to happen anytime soon, given the structure of the country’s health care system. Instead, he says we should work to connect the care delivered in our nation’s emergency departments with the rest of the healthcare system. “ I think this study emphasizes the fact that healthcare coverage doesn’t equate to the ability to see a doctor and people who get emergency care often don’t have primary care or can’t potentially access that care in a timely way. We need to find better ways to connect emergency care to other kinds of care, and make the transition smoother and more seamless for patients.”

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

David Marcozzi, Brendan Carr, Alisha Liferidge, Nicole Baehr, Brian Browne. Trends in the Contribution of Emergency Departments to the Provision of Health Care in the USA. International Journal of Health Services, 2017; 002073141773449 DOI: 10.1177/0020731417734498

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 20, 2017 by Marie Benz MD FAAD