title: Health care utilization before and after an outpatient ED visit in older people.
abstract: BACKGROUND
  Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population.
  
  
  OBJECTIVE
  The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults.
  
  
  METHODS
  This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits.
  
  
  RESULTS
  Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P < .001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status.
  
  
  CONCLUSIONS
  Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. cph4@duke.edu
authors.forename: Carolyn
authors.initials: C
authors.lastname: Horney
authors.forename: Kenneth
authors.initials: K
authors.lastname: Schmader
authors.forename: Linda L
authors.initials: LL
authors.lastname: Sanders
authors.forename: Mitchell
authors.initials: M
authors.lastname: Heflin
authors.forename: Luna
authors.initials: L
authors.lastname: Ragsdale
authors.forename: Eleanor
authors.initials: E
authors.lastname: McConnell
authors.forename: Michael
authors.initials: M
authors.lastname: Hocker
authors.forename: S Nicole
authors.initials: SN
authors.lastname: Hastings
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric