title: Factors Associated With Emergency Department Visits: A Multistate Analysis of Adult Fee-for-Service Medicaid Beneficiaries.
abstract: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia.
  
  
  
  A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file.
  
  
  
  In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96).
  
  
  
  Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.
authors: Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
authors: Parul
authors: P
authors: Agarwal
authors: Department of Health Policy, Management and Leadership, School of Public Health, West Virginia University, Morgantown, WV, USA.
authors: Thomas K
authors: TK
authors: Bias
authors: Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
authors: Suresh
authors: S
authors: Madhavan
authors: School of Professional Studies, Northwestern University, Chicago, IL, USA.
authors: Nethra
authors: N
authors: Sambamoorthi
authors: Department of Health Policy, Management and Leadership, School of Public Health, West Virginia University, Morgantown, WV, USA.
authors: Stephanie
authors: S
authors: Frisbee
authors: Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
authors: Usha
authors: U
authors: Sambamoorthi
keywords: access to care; community health; emergency visits; medical cost; primary care