title: Patient-reported reasons for emergency department visits in the urban Medicaid population.
abstract: This study investigated patient-reported reasons for treat-and-release emergency department (ED) visits by Medicaid beneficiaries. An in-house-designed educational survey was conducted that consisted of 3 components: patient's health, patient's primary care, and patient's ED visit. An ED patient was asked an open-ended question about the reason for a recent ED visit. The patient's answer was classified into 1 of 3 types: health care service delivery issues, population behavior issues, and unavoidable ED visits. Among 2711 ED visits, 56% were related to health care service delivery issues (ie, access to care, primary care provider [PCP] availability), 2% were associated with population behavior issues, and 42% were unavoidable. For those ED visits related to PCP unavailability, 72% occurred during off-hours or weekends and 28% were because of no timely PCP appointments. The findings suggest that inadequate access to primary care is a major cause of potentially avoidable ED utilization in the Medicaid population.
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD linwang@jhmi.edu.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: UnitedHealthcare Community Plan of Maryland, Elkridge, MD.
authors.forename: Nikolay
authors.initials: N
authors.lastname: Tchopev
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Kara
authors.initials: K
authors.lastname: Kuntz-Melcavage
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hawkins
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Regina
authors.initials: R
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000328:Adult; D015142:Baltimore; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D057566:Self Report; D014481:United States; D014505:Urban Population; D055815:Young Adult
keywords: Medicaid; access to care; emergency department; emergency room; primary care