title: Factors influencing inappropriate use of ED visits among type 2 diabetics in an evidence-based management programme.
abstract: OBJECTIVE
  This study analyses inappropriate use of emergency department (ED) services among type 2 diabetics under an evidence-based management programme.
  
  
  METHODS
  Using 1999-2006 databases of Louisiana Health Care Services Division (HCSD) eight public hospitals ED visits among the uninsured and other patients in Louisiana, we termed urgent ED visits appropriate and less-urgent visits inappropriate. Eliminating weekend ED visits, 17,458 urgent and 22,395 less-urgent visits by 8596 patients were analysed, using generalized estimating equation methods.
  
  
  RESULTS
  Caucasians were 0.82 times (95% CI: 0.751-0.889) less likely to use the ED inappropriately compared with African Americans. Patients with commercial insurance, Medicaid and Medicare used the ED more inappropriately than uninsured, with odds ratios of 1.28, 1.32 and 1.28, respectively. Patients hospitalized the prior year were 0.84 times (95% CI: 1.08-1.31) less likely for inappropriate. Patients in larger hospitals used the ED more inappropriately, with an odds ratio of 1.44 (95% CI: 1.32-1.56).
  
  
  CONCLUSIONS
  The study suggests that inappropriate use of the ED among diabetic patients in an evidence-based management programme is more likely to occur among African American, patients with insurance coverage and those seeking care in larger hospitals. Reinforcing the regular use of clinic services for diabetes management, providing clinic access in off-hours, and engaging the health plans in providing incentives for more appropriate use of the ED might reduce inappropriate ED visits. Notably, uninsured patients with diabetes from HCSD were more efficient users of the ED.
authors.affiliation: Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan. chiouatg2@gmail.com
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Chiou
authors.forename: Claudia
authors.initials: C
authors.lastname: Campbell
authors.forename: Leann
authors.initials: L
authors.lastname: Myers
authors.forename: Richard
authors.initials: R
authors.lastname: Culbertson
authors.forename: Ronald
authors.initials: R
authors.lastname: Horswell
mesh_terms: D003924:Diabetes Mellitus, Type 2; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States