Chartbook on Care Coordination

• Emergency department (ED) visits are costly.
• Because some visits are potentially avoidable, they may be indicative of:
  • Poor care management.
  • Inadequate access to care.
  • Poor choices on the part of beneficiaries (Dowd, 2014).

Potentially Avoidable Emergency Department Visits

• ED visits for conditions that are preventable or treatable with appropriate primary care lower health system efficiency and raise costs (Enard & Ganelin, 2013).
• An estimated 13% to 27% of ED visits in the United States could be managed in physician offices, clinics, and urgent care centers, saving $4.4 billion annually (Weinick, et al., 2010).

Potentially Avoidable Emergency Department Visit Measures

• Measures of potentially avoidable ED visits include:
  • ED visits with a principal diagnosis related to mental health, alcohol, or substance abuse.
  • ED visits with a principal diagnosis of dental conditions.
  • ED visits for asthma, ages 18-39.
  • ED visits for asthma, ages 2-17.

Emergency Department Visits Related to Mental Health, Alcohol, or Substance Abuse

Emergency department visits with a principal diagnosis related to mental health, alcohol, or substance abuse, by age and income, 2007-2011

Left Chart:

Right Chart:

Key: Q = quartile.
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, and HCUPnet query, 2007-2011.

• From 2007-2011, the overall rate of ED visits with a principal diagnosis related to mental health, alcohol, or substance abuse significantly increased from 1,527.8 to 1,766.8 per 100,000 population.
• In all years, individuals ages 0-17 and 65 and over were significantly less likely than individuals ages 18-44 to have an ED visit with a principal diagnosis related to mental health, alcohol, or substance abuse.
• In 2011, individuals in the highest income quartile were less likely to have an ED visit with a principal diagnosis related to mental health, alcohol, or substance abuse than individuals in all other income groups.

Emergency Department Visits Related to Mental Health Only

Emergency department visits with a principal diagnosis related to mental health ONLY, by region and income, 2007-2011

Left Chart:

Right Chart:

Key: Q = quartile.
Source: Agency for Healthcare Research and Quality (AHRQ, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, and HCUPnet query, 2007-2011.

• From 2007 to 2011, the overall rate of ED visits with a principal diagnosis related to mental health increased from 1,063.5 to 1,193.1 per 100,000 population.
• In all years, individuals in the highest income quartile were less likely to have an ED visit with a principal diagnosis related to mental health than individuals in all other income groups.
• In 2011, the rate of ED visits with a principal diagnosis related to mental health was lowest for individuals in the West (934.4 per 100,000 population) and highest in the Northeast (1,681.5 per 100,000 population).
• In 4 of 5 years, residents of micropolitan areas were more likely than residents of large fringe metropolitan areas (suburbs) to have an ED visit with a principal diagnosis related to mental health (data not shown).

Emergency Department Visits With a Diagnosis of Substance Abuse Only

Emergency department visits with a principal diagnosis of substance abuse ONLY, by region and income, 2007-2011

Left Chart:

Right Chart:

Key: Q = quartile.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, and HCUPnet query, 2007-2011.

• From 2007 to 2011, the overall rate of ED visits with a principal diagnosis of substance abuse increased from 437.7 to 540.0 per 100,000 population.
• In all years, individuals in the highest income quartile were less likely to have an ED visit with a principal diagnosis of substance abuse than individuals in the first income quartile. In 4 of 5 years, individuals in the highest income quartile were less likely than individuals in the second quartile to have an ED visit with a principal diagnosis of substance abuse.
• In 2011, the rate of ED visits with a principal diagnosis of substance abuse was lowest for individuals in the South (393.8 per 100,000 population) and highest in the Northeast (1,022.7 per 100,000 population).
• In 4 of 5 years, residents of large central metropolitan areas were more likely to have an ED visit with a principal diagnosis of substance abuse than residents of large fringe metropolitan areas. Residents of noncore areas, however, were less likely to have an ED visit with a principal diagnosis of substance abuse than residents of large fringe metropolitan areas in 3 of 5 years.

Emergency Department Visits for Dental Conditions

Emergency department visits with a principal diagnosis of dental conditions, by age and geographic location, 2009-2011

Left Chart:

Right Chart:

Key: MSA = metropolitan statistical area.
Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample, and HCUPnet query, 2007-2011.
Note: Data not available for 2009 for geographic location.

• In 2011, individuals ages 18-44 had the highest rate of ED visits with a principal diagnosis of dental conditions, followed by ages 45-64, 0-17, 65-84, and 85 and over (611.8, 202.8, 106.9, 54.2, and 44.8 per 100,000 population, respectively).
• In 2011, the rate of ED visits with a principal diagnosis of dental conditions was lower for residents of large fringe metropolitan areas than medium metropolitan, micropolitan, and noncore areas (236.1, 360.7, and 455.8 per 100,000 population, respectively).

Emergency Department Visits for Asthma

Emergency department visits for asthma, ages 18-39, by hospital region and income, 2008-2011

Left Chart:

Right Chart:

Key: Q = quartile. Income = median household income of patient’s ZIP Code.
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, version 4.4, 2008-2011.

• From 2008 to 2011, rates of ED visits for asthma were highest in the Northeast and lowest in the West. In 2011, the rate of ED visits for asthma in the Northeast was 864.6 per 100,000 population, followed by the Midwest (677.9 per 100,000 population), the South (522.6 per 100,000 population), and the West (388.4 per 100,000 population).
• In all years, adults with the highest income were significantly less likely than all other income groups to have an ED visit for asthma.

Emergency department visits for asthma, ages 2-17, by hospital region and income, 2008-2011

Left Chart:

Right Chart:

Key: Q = quartile.
Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, version 4.4, 2008-2011.

• From 2008 to 2011, rates of ED visits for asthma were highest in the Northeast and lowest in the West. In 2011, the rate of ED visits for asthma in the Northeast was 1,199.5 per 100,000 population, followed by the South (1,058.7 per 100,000 population), the Midwest (879.1 per 100,000 population), and the West (603.6 per 100,000 population).
• In all years, children in households in the highest income quartile were significantly less likely than all other income groups to have an ED visit for asthma.

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