Understanding ed use: From left, Green, Megan Renfrew, DSC senior project coordinator, and Landry
Over the last 10 years, Emergency Department (ED) utilization rates have increased at double the rate of growth of the U.S. population. To explore the high and rising utilization of EDs across the country and in Massachusetts – which is ranked number 12 on a list of states with the highest ED visits per 1,000 individuals – Alden Landry, MD, MPH, Aetna/MGH Disparities Solutions Center (DSC) HealthCare Disparities fellow, presented “Emergency Department Utilization: Who Uses the Emergency Department and Why?” on June 16. Landry gave the lecture as part of the DSC series, “Racial and Ethnic Disparities: Keeping Current.”
“We must understand the reasons behind high ED utilization rates because an important part of providing high-quality, cost-effective care is providing that care at the right time and right place,” says Landry, who also is an emergency medicine physician and associate director of the Office of Multicultural Affairs at Beth Israel Deaconess Medical Center. “Sometimes patients need care in the ED, but other times a clinic is the more appropriate setting.”
Landry began the presentation with statistics about average ED usage and by sharing data that debunks common utilization myths. For example, while many believe the uninsured use the ED at higher rates than the insured, studies suggest rates for both are about the same. Although African Americans have been found to utilize the ED at higher rates than other ethnicities, Hispanics visit the ED at close to the same rates as non-Hispanics, and noncitizens do not use the ED at significantly higher rates than citizens.
There is, however, a specific group of ED patients known as “ultra-high users,” who are often mentally ill, substance abusers, homeless or chronically sick. While these patients account for only 4 percent of the total population but 20 percent of all ED visits, Landry said, the patients causing the current upward trend in ED utilization rates are actually middle- to upper-class patients who are usually insured and seeking care for less urgent problems – such as bronchitis or urinary tract infections.
One of the top reasons patients use the ED for “primary care treatable” health issues, Landry explained, is simply convenience. At the ED, patients can be seen right away at any hour of the day, rather than wait two weeks for an appointment. Patients also believe that they may receive higher quality care or have better access to specialty care in ED settings. To complicate matters, because the ED is a source of revenue, hospitals sometimes promote them and even advertise short ED wait times.
In closing, Landry offered multiple suggestions for reducing utilization rates, including employing ED-specific case managers, collaborating more closely with community health centers, co-locating urgent care centers within or near an ED, and offering patients a robust primary care system.
“By putting more resources toward primary care and patient education, we can make a significant impact on their health,” says Landry.
At present, Landry and DSC Associate Director Alexander Green, MD, MPH – who introduced Landry at the start of the program – are conducting further research into the reasons why patients come to the ED. For more information about the DSC, visit www2.massgeneral.org/disparitiessolutions.