Chronic Conditions, Hospital Admissions, and Their Relationship to ED Crowding: Improving Quality of Care and Utilization While Reducing Disparities
Limited research has been done to examine emergency department (ED) admissions as a percentage all hospital admissions and to assess the trends in ED utilization over time.
To examine relationships between ED utilization, race, insurance status and access to care. To identify priority conditions upon which to explore implications for access and quality improvement efforts.
Design, Setting, and Participants
Cross-sectional data of over 19 million patients hospitalized in the 1995-2001 National Inpatient Sample were weighted to reflect national totals.
Main Outcome Measures
Percent and likelihood of ED admission among all hospital admission in general and as related to race, insurance status, specific clinical conditions, length of stay, and morality rates.
Percentages of hospital admissions through the ED has progressively increased over time; specifically as related to 16 clinical conditions, mostly chronic. Decreased utilization has been noted for diseases that have been focal points of improvement efforts (e.g., heart failure, acute myocardial infarction, asthma, and cerebral occlusion) while other conditions have shown increased utilization. Disparities of constant magnitude were noted with respect to race and most categories of insurance status. Disparities of increasing magnitude were observed with respect to the uninsured. While trends regarding mortality and length of stay have shown improvements, disparities persisted, especially with respect to the uninsured. Access to care was a significant etiologic factor with areas having higher provider to population ratios showing reduced ED utilization.
Quality improvement efforts need to promote evidence based approaches to chronic conditions where increased ED utilization has been demonstrated including diabetes mellitus and affective psychosis. Access to care by promoting optimal provider to population ratios needs to be prioritized as a cost effective, quality improvement measure. Access to care for uninsured populations should be improved by expansion of availability of insurance benefits.
Emergency Medicine | Health and Medical Administration
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Shen, J. J.,
Washington, E. L.
Chronic Conditions, Hospital Admissions, and Their Relationship to ED Crowding: Improving Quality of Care and Utilization While Reducing Disparities.
Racial and Ethnic Disparities in Health and Healthcare