title: The association between office-based provider visits and emergency department utilization among Medicaid beneficiaries.
abstract: The purpose of our study was to describe the relationship between office-based provider visits and emergency department (ED) utilization by adult Medicaid beneficiaries. Data were extracted from the publicly-available Medical Expenditure Panel Survey, a nationally representative sample of the civilian non-institutionalized population in the United States. The sample included 1,497 respondents who had full year Medicaid coverage in 2009. Study variables included insurance coverage type, usual source of care, chronic illnesses, and beneficiary demographics. Multivariate analyses were conducted to describe associations between individual characteristics and (a) likelihood of any ED utilization, and (b) number of ED visits by those who utilized the ED at least once in the study year. The analysis was adjusted for demographic characteristics and chronic health conditions. A greater number of office-based provider visits was associated with a higher likelihood of ED utilization. Among those with at least one ED visit, a greater number of office-based visits was associated with a higher number of ED visits. A respondent's age, history of hypertension or myocardial infarction, and Hispanic/Latino ethnicity were associated with having one or more ED visits; age and Hispanic/Latino ethnicity were associated with total number of ED visits among those with at least one. In this representative sample of adult Medicaid beneficiaries, there was no evidence that office-based provider visits reduced ED utilization. Office visits were associated with higher ED utilization, as were certain chronic conditions, older age, and Hispanic/Latino ethnicity. Findings do not support efforts to reduce ED utilization by increasing office-based visits alone.
authors.affiliation: Texas A&M Health Science Center College of Medicine, 2401 South 31st Street, Temple, TX, 76508, USA, widmer@medicine.tamhsc.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Widmer
authors.forename: Rashmita
authors.initials: R
authors.lastname: Basu
authors.forename: Angela K
authors.initials: AK
authors.lastname: Hochhalter
mesh_terms: D000328:Adult; D000367:Age Factors; D001249:Asthma / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D018802:Patient-Centered Care; D012959:Socioeconomic Factors; D014481:United States