title: Nonemergent emergency department use among patients with a usual source of care.
abstract: OBJECTIVE
  Emergency department (ED) use for nonemergent conditions is associated with discontinuity of care at a greater cost. The objective of this study was to determine whether the quality of patient-provider communication and access to one's usual source of care (USC) were associated with greater nonemergent ED use.
  
  
  METHODS
  A hurdle model was employed using data from the 2007 to 2009 Medical Expenditure Panel Survey. First, a multivariate logistic regression model was used to identify factors associated with the likelihood of a nonemergent ED visit. Given that one occurrence exists, a second negative binomial model was used to establish whether patient-provider communication or access are related to the frequency of nonemergent ED use.
  
  
  RESULTS
  One element of communication, patient-provider language concordance, is associated with fewer nonemergent ED visits (P < .05). Several aspects of access are related to reduced ED use for nonemergent purposes. Patients whose USC is available after hours and those who travel less than an hour to get to their USC use the ED less for nonemergent care (P ≤ .05).
  
  
  CONCLUSIONS
  Enhancing primary care by expanding interpreter services and access to care after hours may reduce the demand for nonemergent ED services.
authors.affiliation: the Department of Health Services Administration, University of Maryland, College Park.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Villani
authors.forename: Karoline
authors.initials: K
authors.lastname: Mortensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Delivery of Health Care; Emergency Treatment; Health Services Research; Physician-Patient Relations