Delcher Chris, Yang Chengliang, Ranka Sanjay, Tyndall Joseph Adrian, Vogel Bruce, Shenkman Elizabeth
Institute for Child Health Policy, Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
Department of Computer and Information Science and Engineering, University of Florida, Gainesville, FL, USA.
Int J Emerg Med. 2017 Dec 4;10(1):31. doi: 10.1186/s12245-017-0157-4.
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.
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.
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.
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.
在州层面，门诊急诊科（ED）的频繁使用——即所谓的“过度使用”——尚未得到充分研究。为填补这一空白，我们对迄今为止最大的州医疗补助人群中的急诊科频繁使用情况进行了研究。
利用得克萨斯州医疗补助计划（美国第三大医疗补助计划）的理赔数据，我们研究了每年急诊科使用七个水平（即1次、2次、3 - 4次、5 - 6次、7 - 9次、10 - 14次和≥15次就诊）的支出、社会人口统计学、合并症及持续性方面的差异。我们使用纽约大学最新算法将就诊分为紧急和非紧急类别。
2014年，31%（n = 346,651）的得克萨斯州医疗补助成年参保者至少去过一次急诊科。就诊≥3次的参保者占所有成年患者的8.5%，占急诊就诊总数的60.4%，占急诊总支出的62.1%。急诊极度频繁使用者（≥10次急诊就诊）占所有使用者的比例不到1%，但占所有急诊就诊的15.5%，占急诊总费用的17.4%。随着急诊就诊次数增加，被分类为非紧急或紧急但可由初级保健治疗的急诊就诊比例变化不大。总体而言，约13%的急诊就诊被认为是不可预防或不可避免的。
得克萨斯州医疗补助人群患有大量慢性病，随着年度就诊次数增加，药物使用和心理健康诊断仅有适度增加。了解导致频繁使用急诊科的特征对于制定减少高使用率的策略和医疗补助政策至关重要。
