title: Emergency department use: a reflection of poor primary care access?
abstract: OBJECTIVE
  To determine whether the use of the emergency department (ED) for nonurgent care reflects poor access to community-based primary care providers (PCPs).
  
  
  METHODS
  Using a survey of ED patients, insurance claims data, and administrative records identifying demographic factors, we analyzed the use of the ED in an impoverished area of Brooklyn, New York.
  
  
  METHODS
  We examined original survey data to investigate the extent to which residents of northern and central Brooklyn use EDs for nonemergencies and whether these patients have access to PCPs. We used data from health insurers operating in northern and central Brooklyn, and New York state hospital ED visit data to investigate the factors influencing ED visits for ambulatory care-sensitive conditions (ACSCs). Logistic regression was used to identify characteristics that predict ED visits not resulting in admission for ACSCs.
  
  
  RESULTS
  Of 11,546 patients that completed our survey, the presenting complaint was self-described as emergent by 57%, 30% had no PCP, and 19% reported no health insurance coverage. Using health insurance plan encounter data, only 15 % of patients had seen any provider within 1 week of the ED visit. Insurance type, age, gender, race/ethnicity, and socioeconomic status of area of residence influence the likelihood of these ED visits.
  
  
  CONCLUSIONS
  Correlating data from 3 sources, we suggest that the expansion of insurance under the Affordable Care Act may not be sufficient to reduce ED use for nonurgent conditions.
authors.affiliation: 722 W 168th St, Room 1403, Mailman School of Public Health, Columbia University, New York, NY 10032. E-mail: dw2493@columbia.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisz
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gusmano
authors.forename: Grace
authors.initials: G
authors.lastname: Wong
authors.forename: John
authors.initials: J
authors.lastname: Trombley
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D058991:Patient Protection and Affordable Care Act / Q000458:organization & administration; D011203:Poverty; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D018570:Risk Assessment; D012959:Socioeconomic Factors