School of Public Health, West Virginia University, Morgantown, West Virginia, USA.
Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Health Serv Res. 2021 Aug;56(4):721-730. doi: 10.1111/1475-6773.13631. Epub 2021 Feb 8.
To estimate the impact of urgent care centers on emergency department (ED) use.
Secondary data from a novel urgent care center database, linked to the Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) from six states.
We used a difference-in-differences design to examine ZIP code-level changes in the acuity mix of emergency department visits when local urgent care centers were open versus closed. ZIP codes with no urgent care centers served as a control group. We tested for differential impacts of urgent care centers according to ED wait time and patient insurance status.
DATA COLLECTION/EXTRACTION METHODS: Urgent care center daily operating times were determined via the urgent care center database. Emergency department visit acuity was assessed by applying the NYU ED algorithm to the SEDD data. Urgent care locations and nearby emergency department encounters were linked via zip code.
We found that having an open urgent care center in a ZIP code reduced the total number of ED visits by residents in that ZIP code by 17.2% (P < 0.05), due largely to decreases in visits for less emergent conditions. This effect was concentrated among visits to EDs with the longest wait times. We found that urgent care centers reduced the total number of uninsured and Medicaid visits to the ED by 21% (P < 0.05) and 29.1% (P < 0.05), respectively.
During the hours they are open, urgent care centers appear to be treating patients who otherwise would have visited the ED. This suggests that urgent care centers have the potential to reduce health care expenditures, though questions remain about their net cost impact. Future work should assess whether urgent care centers can improve health care access among populations that often experience barriers to receiving timely care.
评估紧急护理中心对急诊部门（ED）使用的影响。
一项新颖的紧急护理中心数据库的二级数据，与来自六个州的医疗保健成本和利用项目州急诊部门数据库（SEDD）相关联。
我们使用差异中的差异设计来检查当地紧急护理中心开放与关闭时急诊就诊的紧急程度组合的邮政编码级别的变化。没有紧急护理中心的邮政编码作为对照组。我们根据急诊等待时间和患者保险状况测试紧急护理中心的不同影响。
数据收集/提取方法：通过紧急护理中心数据库确定紧急护理中心的日常运营时间。通过将 NYU ED 算法应用于 SEDD 数据来评估急诊就诊的紧急程度。通过邮政编码链接紧急护理中心的位置和附近的急诊就诊。
我们发现，在一个邮政编码中开设一个开放的紧急护理中心，可将该邮政编码居民的急诊就诊总数减少 17.2%（P<0.05），主要是由于不太紧急的情况下就诊人数减少。这种效果集中在等待时间最长的急诊就诊中。我们发现，紧急护理中心将未参保和医疗补助的急诊就诊总数分别减少了 21%（P<0.05）和 29.1%（P<0.05）。
在开放时间内，紧急护理中心似乎在治疗那些原本会去急诊的患者。这表明紧急护理中心有可能降低医疗保健支出，但仍存在有关其净成本影响的问题。未来的工作应评估紧急护理中心是否可以改善经常面临及时获得护理障碍的人群的医疗保健获取。
