Reducing Emergency Department Costs By Improving Ambulatory Care

Haichang Xin, PhD Department of Health Care Organization and policy School of Public Health University of Alabama at BirminghamMedicalResearch.com Interview with:
Haichang Xin, PhD
Department of Health Care Organization and policy
School of Public Health
University of Alabama at Birmingham


MedicalResearch:
What is the background for this study?

Dr. Xin: Research suggests that nearly half of all emergency department (ED) visits in the United States are for nonurgent conditions, leading to billions of dollars in potentially avoidable spending annually. A well-functioning primary care system has the capacity to provide timely, adequate, and effective care for patients in order to avoid nonurgent emergency department use and care costs.

This study examined how deficiencies in ambulatory care were associated with nonurgent emergency department care costs nationwide, and to what extent these costs can be reduced if deficiencies in primary care systems could be improved.

MedicalResearch: What are the main findings?

Dr. Xin: Patient perceived poor and intermediate levels of primary care quality had higher odds of nonurgent emergency department care costs (OR=2.22, p=0.035, and OR=2.05, p=0.011, respectively) compared to high quality care, with a marginal effect (at means) of 13.0% and 11.5% higher predicted probability of nonurgent ED care costs.

These ambulatory care quality deficiency related costs amounted up to $229 million for private plans (95% CI: $100 million, $358 million), $58.5 million for public plans (95% CI: $33.9 million, $83.1 million), and an overall of $379 million (95% CI: $229 million, $529 million) at the national level.

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

Dr. Xin: These findings highlight the target areas and inform policies on effective strategies in reducing nonurgent ED care costs. Without improving ambulatory care quality, endeavors simply aiming to encourage the use of outpatient clinics and community health centers, to increase primary care supply, or to increase ED cost sharing levels may not be effective in improving healthcare system efficiency and reducing healthcare costs.

These ambulatory care quality deficiency related costs amounted up to hundreds of millions dollars. If deficiencies in primary care systems could be improved, these substantial amounts of costs can be reduced nationwide.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Xin: Future studies may consider examining specific deficiency areas in ambulatory care quality that are associated with nonurgent ED care costs. Future research may also consider revealing a causal relationship between deficiencies in ambulatory care system and nonurgent ED care costs.

Citation:

Xin, H, Kilgore, ML, Sen, B, Blackburn J.  “Can nonurgent emergency department care costs be reduced? Empirical evidence from a U.S. nationally representative sample”. Journal of Emergency Medicine. 2015, In Press

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MedicalResearch.com Interview with: Haichang Xin, PhD (2015). Reducing Emergency Department Costs By Improving Ambulatory Care 

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