title: Reasons for using the emergency department: results of the EMPATH Study.
abstract: OBJECTIVE
  Emergency Medicine Patients' Access To Healthcare (EMPATH) was a cross-sectional, observational study conducted to identify the principal reasons why patients seek care in hospital emergency departments (EDs) in the United States.
  
  
  METHODS
  Twenty-eight U.S. hospitals, stratified by geographic region and hospital characteristics, participated in this study. Demographic, clinical, and insurance data were collected for a 24-hour period at each site, using chart reviews and a structured interview administered to all consenting adult patients seeking treatment during that period. Patients' reasons for presenting to the ED were assessed by their level of agreement (on a three-point Likert scale) with 21 carefully worded statements designed to capture a range of possible reasons for seeking care in the ED. Factor analysis was used to consolidate highly correlated responses and to identify the principal factors explaining patients' reasons for coming to the ED.
  
  
  RESULTS
  A total of 1,579 patient interviews and 2,004 chart reviews were obtained from a diverse sample that was 55.4% female, 58.3% white, 28.3% African American, 7.0% Hispanic, and 6.0% other ethnic groups. This exploratory analysis yielded five factors characterizing patients' principal reasons for seeking ED care, with medical necessity the most frequent, followed by ED preference, convenience, affordability, and limitations of insurance.
  
  
  CONCLUSIONS
  Use of the ED is, for most people, an affirmative choice over other providers rather than a last resort; it is often a choice driven by lack of access to or dissatisfaction with other sources of care.
authors.affiliation: Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Deborah Fish
authors.initials: DF
authors.lastname: Ragin
authors.forename: Ula
authors.initials: U
authors.lastname: Hwang
authors.forename: Rita K
authors.initials: RK
authors.lastname: Cydulka
authors.forename: Dave
authors.initials: D
authors.lastname: Holson
authors.forename: Leon L
authors.initials: LL
authors.lastname: Haley
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Richards
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Becker
authors.forename: Lynne D
authors.initials: LD
authors.lastname: Richardson
mesh_terms: D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005163:Factor Analysis, Statistical; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data; D017678:Sex Distribution; D014481:United States