title: Reducing variation in hospital admissions from the emergency department for low-mortality conditions may produce savings.
abstract: The emergency department (ED) is now the primary source for hospitalizations in the United States, and admission rates for all causes differ widely between EDs. In this study we used a national sample of ED visits to examine variation in risk-standardized hospital admission rates from EDs and the relationship of this variation to inpatient mortality for the fifteen most commonly admitted medical and surgical conditions. We then estimated the impact of variation on national health expenditures under different utilization scenarios. Risk-standardized admission rates differed substantially across EDs, ranging from 1.03-fold for sepsis to 6.55-fold for chest pain between the twenty-fifth and seventy-fifth percentiles of the visits. Conditions such as chest pain, soft tissue infection, asthma, chronic obstructive pulmonary disease, and urinary tract infection were low-mortality conditions that showed the greatest variation. This suggests that some of these admissions might not be necessary, thus representing opportunities to improve efficiency and reduce health spending. Our data indicate that there may be sizeable savings to US payers if differences in ED hospitalization practices could be narrowed among a few of these high-variation, low-mortality conditions.
authors.affiliation: Amber K. Sabbatini is an instructor of emergency medicine at the University of Washington, in Seattle.
authors.forename: Amber K
authors.initials: AK
authors.lastname: Sabbatini
authors.affiliation: Brahmajee K. Nallamothu is an associate professor of cardiovascular medicine at the University of Michigan; a core investigator at the Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center; a faculty member at the Center for Healthcare Outcomes and Policy; and a faculty member at the Institute for Healthcare Policy and Innovation, all in Ann Arbor.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: Keith E. Kocher (kkocher@umich.edu) is an assistant professor in emergency medicine at the University of Michigan; a faculty member at the Center for Healthcare Outcomes and Policy; and a faculty member at the Institute for Healthcare Policy and Innovation.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Kocher
mesh_terms: D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000191:economics* / Q000706:statistics & numerical data*; D018570:Risk Assessment; D014481:United States
keywords: Cost of Health Care; Health Spending; Hospitals; Organization and Delivery of Care; Variations