title: A multisite survey of factors contributing to medically unnecessary ambulance transports.
abstract: OBJECTIVE
  To determine the social and demographic factors associated with medically unnecessary ambulance utilization, and to determine the willingness of patients to use alternate modes of transportation to the ED.
  
  
  METHODS
  A multisite prospective survey was conducted of all patients arriving by ambulance to 1 suburban and 4 urban EDs in New York State during a 1-week period.
  
  
  RESULTS
  For 626 patients surveyed, 71 (11.3%) transports were judged medically unnecessary by the receiving emergency physicians using preestablished guidelines. The patient's type of medical insurance and age were significant predictors of unnecessary ambulance transport (stepwise forward logistic regression analysis). Of the 71 patients whose ambulance transports were deemed medically unnecessary, 42 (59%) were Medicaid recipients and 53 (74%) were < 40 years of age. The most common reason for using ambulance transport was lack of an alternate mode of transportation (38.5%), although 82% would have been willing to use an alternate mode of transportation if it had been available. Of those who had medically unnecessary ambulance use, 30% indicated that they would not pay for the ambulance service if billed and 50% believed the cost of their ambulance transports was < $100. More than 85% of the patients whose ambulance transports were deemed medically unnecessary were unemployed; and nearly 85% reported a net annual income of < $20,000. While 33% had a primary care provider, only 22% had attempted to contact their doctors before requesting an ambulance.
  
  
  CONCLUSIONS
  Patient age < 40 years and Medicaid coverage were associated with medically unnecessary ambulance use. Those patients for whom ambulance use was considered medically unnecessary commonly had no alternate means of transportation. Providing alternate means of unscheduled transportation may reduce the incidence of unnecessary ambulance use.
authors.affiliation: State University of New York at Buffalo, Department of Emergency Medicine, USA. lerner@acsu.buffalo.edu
authors.forename: A J
authors.initials: AJ
authors.lastname: Billittier
authors.forename: R
authors.initials: R
authors.lastname: Moscati
authors.forename: D
authors.initials: D
authors.lastname: Janicke
authors.forename: E B
authors.initials: EB
authors.lastname: Lerner
authors.forename: J
authors.initials: J
authors.lastname: Seymour
authors.forename: D
authors.initials: D
authors.lastname: Olsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000552:Ambulances; D002648:Child; D002675:Child, Preschool; D003363:Cost Control; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D011446:Prospective Studies; D014187:Transportation of Patients / Q000191:economics / Q000706:statistics & numerical data*