title: Socioeconomic determinants of overnight and weekend emergency department use for acute rhinosinusitis.
abstract: OBJECTIVE
  Prior work has shown Medicaid and self-pay insurance status is associated with emergency department (ED), rather than outpatient clinic, presentation for uncomplicated acute rhinosinusitis (ARS). We investigate whether the disparate use of ED resources for this nonemergent condition by patients with Medicaid and self-pay insurance can be attributed to presentation overnight or on weekends.
  
  
  METHODS
  Cross-sectional survey of 990,849 patients from the 2009 and 2010 National Hospital Ambulatory Medical Care Survey presenting to EDs with uncomplicated ARS. Patients with orbital and intracranial complications of ARS were excluded.
  
  
  METHODS
  Univariate and multivariate associations identified demographic and socioeconomic characteristics, including insurance status, which were independently associated with overnight (between 5 pm and 7 am) or daytime weekend ED presentation for uncomplicated ARS.
  
  
  RESULTS
  Medicaid or self-pay insurance status was associated with evening/overnight ED presentation (odds ratio=1.88, P=.018) in comparison to private or Medicare insurance. However, weekend daytime ED presentation was not associated with Medicaid or self-pay insurance statuses (P=.144). Income and education levels of patients' zip codes, taken as markers of socioeconomic status, were not associated with either evening/overnight or daytime weekend ED presentation for uncomplicated ARS (P>.05).
  
  
  CONCLUSIONS
  ARS patients with Medicaid or self-pay status, previously shown to preferentially use EDs for uncomplicated ARS, were more likely to present for overnight ED care compared to patients with private insurance or Medicare. These findings suggest a potential lack of access to extended-hours primary care during evenings and nights for Medicaid patients.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery , Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|Department of Otology and Laryngology , Harvard Medical School, Boston, Massachusetts.
authors.forename: Regan W
authors.initials: RW
authors.lastname: Bergmark
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery (s.l.i.).|Division of Pulmonary Medicine , Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.|Department of Otolaryngology-Head & Neck Surgery , University of Cincinnati, Cincinnati, Ohio.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery , Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|Department of Otology and Laryngology , Harvard Medical School, Boston, Massachusetts.
authors.forename: George A
authors.initials: GA
authors.lastname: Scangas
authors.affiliation: Department of Otology and Laryngology , Harvard Medical School, Boston, Massachusetts.|Department of Otolaryngology and Communications Enhancement , Boston Children's Hospital, Boston, Massachusetts, U.S.A.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cunningham
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery , Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|Department of Otology and Laryngology , Harvard Medical School, Boston, Massachusetts.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
mesh_terms: D000208:Acute Disease; D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D006278:Medicare; D012852:Sinusitis / Q000628:therapy*; D012866:Skilled Nursing Facilities / Q000600:supply & distribution; D012959:Socioeconomic Factors; D014481:United States
keywords: Sinusitis; emergency service; healthcare delivery; healthcare disparities; hospital; insurance; socioeconomic factors