title: Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions.
abstract: BACKGROUND
  Hospital care for ambulatory care sensitive conditions (ACSC) is potentially avoidable and often viewed as an indicator of suboptimal primary care. However, potentially preventable encounters with the health care system also occur in emergency department (ED) settings. We examined ED visits to identify subpopulations with disproportionate use of EDs for ACSC care.
  
  
  METHODS
  We analyzed data from the 2007-2009 National Hospital Ambulatory Medical Care Survey for 78,114 ED visits by adults aged 18 and older. Outcomes were ACSC visits determined from the primary ED diagnosis. We constructed analytic groups aligned with Agency for Healthcare Research and Quality's priority populations. Multivariate logistic regression was used to estimate the odds of all-cause, acute, and chronic ACSC visits. We used Stata SE survey techniques to account for the complex survey design.
  
  
  RESULTS
  Overall, 8.4% of ED visits were for ACSC, representing over 8 million potentially avoidable ED visits annually. ACSC visits were more likely to result in hospitalization than non-ACSC visits (34.4% vs. 14.0%, P<0.001). Multivariate models revealed significant disparities in ACSC visits to the ED by race/ethnicity, insurance status, age group, and socioeconomic status, although patterns differed for acute and chronic ACSC.
  
  
  CONCLUSIONS
  Disproportionately higher use of EDs for ACSC care exists for many priority populations and across a broader range of priority populations than previously documented. These differences constitute disparities in potentially avoidable ED visits for ACSC. To avoid exacerbating disparities, health policy efforts to minimize economic inefficiencies in health care delivery by limiting ED visits for ACSC should first address their determinants.
authors.affiliation: Medica Research Institute Divisions of Epidemiology & Community Health, Health Policy & Management, University of MN, Minneapolis 55305, USA. johns245@umn.edu
authors.forename: Pamela Jo
authors.initials: PJ
authors.lastname: Johnson
authors.forename: Neha
authors.initials: N
authors.lastname: Ghildayal
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Ward
authors.forename: Bjorn C
authors.initials: BC
authors.lastname: Westgard
authors.forename: Lori L
authors.initials: LL
authors.lastname: Boland
authors.forename: Jon S
authors.initials: JS
authors.lastname: Hokanson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D002908:Chronic Disease; D003695:Delivery of Health Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult