title: Revisit rates and associated costs after an emergency department encounter: a multistate analysis.
abstract: BACKGROUND
  Return visits to the emergency department (ED) or hospital after an index ED visit strain the health system, but information about rates and determinants of revisits is limited.
  
  
  OBJECTIVE
  To describe revisit rates, variation in revisit rates by diagnosis and state, and associated costs.
  
  
  METHODS
  Observational study using the Healthcare Cost and Utilization Project databases.
  
  
  METHODS
  6 U.S. states.
  
  
  METHODS
  Adults with ED visits between 2006 and 2010.
  
  
  METHODS
  Revisit rates and costs.
  
  
  RESULTS
  Within 3 days of an index ED visit, 8.2% of patients had a revisit; 32% of those revisits occurred at a different institution. Revisit rates varied by diagnosis, with skin infections having the highest rate (23.1% [95% CI, 22.3% to 23.9%]). Revisit rates also varied by state. For skin infections, Florida had higher risk-adjusted revisit rates (24.8% [CI, 23.5% to 26.2%]) than Nebraska (10.6% [CI, 9.2% to 12.1%]). In Florida, the only state with complete cost data, total revisit costs for the 19.8% of patients with a revisit within 30 days were 118% of total index ED visit costs for all patients (including those with and without a revisit).
  
  
  CONCLUSIONS
  Whether a revisit reflects inadequate access to primary care, a planned revisit, the patient's nonadherence to ED recommendations, or poor-quality care at the initial ED visit remains unknown.
  
  
  CONCLUSIONS
  Revisits after an index ED encounter are more frequent than previously reported, in part because many occur outside the index institution. Among ED patients in Florida, more resources are spent on revisits than on index ED visits.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.forename: Reena
authors.initials: R
authors.lastname: Duseja
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Bardach
authors.forename: Grace A
authors.initials: GA
authors.lastname: Lin
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: Mitzi L
authors.initials: ML
authors.lastname: Dean
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Clay
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D004636:Emergency Service, Hospital / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006742:Hospital Bed Capacity; D017721:Hospital Costs; D016304:Hospitals, Private / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D014481:United States; D055815:Young Adult