A well-functioning primary care system has the capacity to provide effective care for patients to avoid nonurgent emergency department (ED) use and related costs. Dr. Haichang Xin, research associate in the department of health care organization and policy at the University of Alabama at Birmingham, recently examined how patients’ perceived deficiency in ambulatory care is associated with nonurgent ED care costs nationwide. UAB co-investigators were department colleagues Dr. Meredith Kilgore, professor and chair; Dr. Bisakha Sen, professor; and Dr. Justin Blackburn, assistant professor.

[Photo: Dr. Haichang Xin]

This retrospective cohort study — using data from the 2010-2011 Medical Expenditure Panel Survey, which is “a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States” — chose usual source of care, convenience of needed medical care, and patient evaluation of care quality as the main independent variables. The marginal effect following a multivariate logit model was employed to analyze the urgent versus nonurgent ED care costs in 2011, after controlling for covariates in 2010. The endogeneity was accounted for by the time lag effect and controlling for education levels. Sample weights and variance were adjusted with the survey procedures to make results nationally representative.

Patient-perceived poor and intermediate levels of primary care quality had higher odds of nonurgent ED care costs (odds ratio [OR] = 2.22, p = 0.035, and OR = 2.05, p = 0.011, respectively) compared with high-quality care, with a marginal effect (at means) of 13.0 percent and 11.5 percent higher predicted probability of nonurgent ED care costs. Costs related to these ambulatory care quality deficiencies amounted to $229 million for private plans (95 percent confidence interval [CI] $100 million to $358 million), $58.5 million for public plans (95 percent CI $33.9 million to $83.1 million), and an overall of $379 million (95 percent CI $229 million to $529 million) nationally.

The researchers concluded that these findings highlight the improvement in ambulatory care quality as the potential target area to effectively reduce nonurgent ED care costs.

“Can Nonurgent Emergency Department Care Costs be Reduced? Empirical Evidence from a U.S. Nationally Representative Sample” was published online in April in The Journal of Emergency Medicine.

Journal article: http://www.jem-journal.com/article/S0736-4679(15)00057-8/abstract