Abstract
Introduction
We study community-level factors associated with emergency department (ED) admission
rates and assessed how they vary across geography.
Methods
We conducted an ecological study using 2012 data from 100% of U.S. Medicare Fee-for-Service
beneficiaries to calculate county-level ED admission rates, adjusted by Hierarchical
Condition Categories to control for patient health. We tested community-level measures
related to healthcare market concentration, healthcare delivery, and socioeconomic
factors potentially associated with admission rates and assessed whether these factors
predicted ED admission rates across counties using ordinary least squares (OLS) regression
and whether they varied across geography using geographically weighted regression
(GWR).
Results
In 3031 U.S. counties, the ED admission rate varied from 3.9% to 82.2%. The lowest
ED admission rates were concentrated in counties in Kansas, Oregon, and Vermont and
the highest ED admission rates were in counties throughout Washington, Wyoming, Texas,
and Colorado. The OLS model found several community-level factors that negatively
impacted admission rates, specifically hospital market concentration, the rate of
hospital beds with urgent care, and the rate of hospital beds. The factors that had
a positive impact on the admission rate include the rate of MDs and factors for disadvantage,
affluence, and foreign born/Hispanic. However, GWR showed the relationship between
the ED admission rate and predictors varied across U.S. counties
Conclusions
The association between healthcare market concentration, healthcare delivery, and
socioeconomic factors with ED admissions differed across communities in Medicare beneficiaries.
This suggests that policy and interventions to reduce ED admissions need to be tailored
to specific community contexts.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Emergency Department Summary Tables.(Available at)
- Emergency department physician-level and hospital-level variation in admission rates.Ann Emerg Med. 2013; 61: 638-643
- Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department.Ann Emerg Med. 2012; 59: 35-41
- Inpatient admissions from the ED for adults with injuries: the role of clinical and nonclinical factors.Am J Emerg Med. 2015; 33: 764-769
- Variation in emergency department admission rates across the United States.Med Care Res Rev. Apr 2013; 70: 218-231
- Variation in emergency department admission rates in U.S. children's hospitals.Pediatrics. 2014; 134: 539-545
- Reducing variation in hospital admissions from the emergency department for low-mortality conditions may produce savings.Health Aff (Millwood). 2014; 33: 1655-1663
- County-Level Variation in Emergency Department Admission Rates Among U.S. Medicare Beneficiaries.Ann Emerg Med. 2016; 68: 456-460
- The Impact of Hospital and Patient Factors on the Emergency Department Decision to Admit.J Emerg Med. 2018; 54: 249-257
- Area Health Resources Files. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce, Rockville, MD2013-2014
- American Community Survey, 2009-2013 American Community Survey 5-Year Estimates.2015
- Territories of inequality: An essay on the measurement and analysis of inequality in grounded place settings.in: Labao L.M. Hooks G. Tickamyers A.R. The Sociology of Spatial Inequality. State University of New York Albany Press, New York2007: 85-109
- Social class, race, and toxic releases in American counties, 1995.Soc Sci J. 2001; 38: 13-25
- Differential mortality across the U.S.: the influence of place-based inequality.in: Lobao L.M. Hooks G. Tickamyer A.R. The Sociology of Spatial Inequality. SUNY Press, Albany, NY2007: 141-162
- Mapping the results of local statistics: using geographically weighted regression.Demogr Res. 2012; 26: 151-166
- Geographically weighted regression: The analysis of spatially varying relationships.Wiley, Chichester2002
- A simplified Monte Carlo significance test procedure.J R Stat Soc B Methodol. 1968; 30: 582-598
- Geographically weighted regression: Modeling spatial non-stationarity.Statistician. 1998; 47: 431-443
- SAS macro programs for geographically weighted generalized linear modeling with spatial point data: Applications to health research.Comput Methods Programs Biomed. 2012; 107: 262-273
- Conceptual Model of Acute Care Episodes in the United States.Ann Emerg Med. 2016; 68: 484-491
Article Info
Publication History
Published online: August 24, 2018
Accepted:
August 22,
2018
Received in revised form:
August 16,
2018
Received:
April 10,
2018
Footnotes
â?†The views expressed in this paper are those of the authors and no official endorsement by the Department of Health and Human Services or the Centers for Medicare & Medicaid Services is intended or should be inferred.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
