U.S. EDs experienced significant increases in patient visits during 10-year interval

Tang N. JAMA. 2010;304:664-670.

Results from a survey of hospital EDs indicated that ED visits were on the rise from 1997 and 2007 and that EDs increasingly served as the safety net for medically underserved patients, particularly adults with Medicaid.

“The total annual visits to U.S. EDs increased by 23% — corresponding to an estimated 21 million additional ED visits nationwide,” the researchers reported in their study. “This is roughly twice the rate of growth of the U.S. population over the same time period.”

In this study, researchers from the University of California, San Francisco, used publicly available ED visit data from the National Hospital Ambulatory Medical Care Survey from 1997 through 2007. The data were stratified by the following: age, sex, race, ethnicity, insurance status, safety-net hospital classification, triage category and disposition. The researchers used codes from the ICD-9 to extract visits related to ambulatory care–sensitive conditions and determined visit rates using annual U.S. Census estimates.

During the 10 years, ED visit rates rose from 352.8 to 390.5 per 1,000 people (rate difference, 37.7; 95% CI, –51.1 to 126.5), with the median ED wait time to see physicians increasing from 22 to 33 minutes (P<.001). Adults with Medicaid accounted for most of the increase in ED visits, with increases in visit rate during 1999 and 2007 from 693.9 to 947.2 visits per 1,000 enrollees (rate difference, 253.3; 95% CI, 41.1-465.5).

Additionally, during the same 8-year period, ED visit rates among adults with Medicaid increased from 66.4 to 83.9 (rate difference, 17.5; 95% CI, -5.8 to 40.8), despite ED visit rates for adults with ambulatory care–sensitive conditions remaining stable. The number of facilities qualifying as safety-net EDs also increased, with numbers starting at 1,770 in 2000 and rising to 2,489 in 2007.

“Even though our study includes the latest available data on U.S. ED visits through 2007, a critical concern is what has happened in more recent years,” the researchers wrote, citing the Medicaid enrollment spike as their main concern, which resulted from an increase in the number of the uninsured due to the severe economic recession that began in 2008.

“Our findings suggest that increased enrollments in Medicaid between 1999 and 2007 have had substantial effects on ED volume and crowding, and that at least part of this may reflect limited access to primary care services for Medicaid enrollees,” they wrote. “A deeper examination of the differential access to primary care by insurance type is needed to better understand health care utilization patterns by patients with Medicaid and to develop more effective strategies for reducing pressure on the safety net.”

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