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Nearly half of US medical care delivered by EDs

Visits to EDs comprise 47.7% of all hospital-associated medical care provided in the United States, according to findings published in the International Journal of Health Services.

“Traditional approaches to assessing the health of populations focus on the use of primary care and the delivery of care through patient-centered homes, managed care resources and accountable care organizations,” David Marcozzi, MD, from the department of emergency medicine at the University of Maryland School of Medicine, and colleagues wrote. “The use of EDs has largely not been given consideration in these models.”

Marcozzi and colleagues investigated how EDs contribute to overall United States health care from 1996 through 2010 in comparison to both outpatient and inpatient sectors. The researchers obtained data from the National Hospital Ambulatory Medical Care Survey and the National Hospital Discharge Survey.

During the study period, more than 3.5 billion health care contacts, defined as ED visits, outpatient visits or hospital admissions, occurred. There was a 43.7% increase in ED visits from 1996 to 2010. In addition, ED visits accounted for nearly half (47.7%) of health care contacts, while outpatient visits accounted for about 44% and inpatient visits accounted for about 15%.

Black patients were significantly more likely to use EDs than other racial groups and used the ED nearly 54% of the time in 2010. Patients without any type of insurance and those living in the South and West were also were significantly more likely to use EDs.

“I was shocked by these results,” Marcozzi told Healio Internal Medicine. “This really helps us understand health care in this country. This research underscores the fact that EDs are critical to our nation’s health care delivery system, particularly for Americans who have no access to care. Patients seek care delivered in EDs for many reasons, and we need to face this fact that this is a significant segment of health care and actually it may be delivering the type of care that individuals want and need, 24/7.”

Connecting ED care with the rest of the United States’ health care system is critical, according to Marcozzi.

“This study emphasizes the importance of emergency care in our nation. Health care coverage doesn’t equate to the ability to see a doctor and people who get emergency care often don’t have primary care or can’t access that care in a timely way,” he said. “We need to find better ways to connect emergency care to other kinds of care, and make the transition smoother and more seamless for patients.” – by Alaina Tedesco

Disclosure: Marcozzi and colleagues report no relevant financial disclosures.