title: Association Between the Opening of Retail Clinics and Low-Acuity Emergency Department Visits.
abstract: OBJECTIVE
  We assess whether the opening of retail clinics near emergency departments (ED) is associated with decreased ED utilization for low-acuity conditions.
  
  
  METHODS
  We used data from the Healthcare Cost and Utilization Project State Emergency Department Databases for 2,053 EDs in 23 states from 2007 to 2012. We used Poisson regression models to examine the association between retail clinic penetration and the rate of ED visits for 11 low-acuity conditions. Retail clinic "penetration" was measured as the percentage of the ED catchment area that overlapped with the 10-minute drive radius of a retail clinic. Rate ratios were calculated for a 10-percentage-point increase in retail clinic penetration per quarter. During the course of a year, this represents the effect of an increase in retail clinic penetration rate from 0% to 40%, which was approximately the average penetration rate observed in 2012.
  
  
  RESULTS
  Among all patients, retail clinic penetration was not associated with a reduced rate of low-acuity ED visits (rate ratio=0.999; 95% confidence interval=0.997 to 1.000). Among patients with private insurance, there was a slight decrease in low-acuity ED visits (rate ratio=0.997; 95% confidence interval=0.994 to 0.999). For the average ED in a given quarter, this would equal a 0.3% reduction (95% confidence interval 0.1% to 0.6%) in low-acuity ED visits among the privately insured if retail clinic penetration rate increased by 10 percentage points per quarter.
  
  
  CONCLUSIONS
  With increased patient demand resulting from the expansion of health insurance coverage, retail clinics may emerge as an important care location, but to date, they have not been associated with a meaningful reduction in low-acuity ED visits.
authors.affiliation: RAND Corporation, Pittsburgh, PA. Electronic address: martsolf@rand.org.
authors.forename: Grant
authors.initials: G
authors.lastname: Martsolf
authors.affiliation: Truven Health Analytics, Santa Barbara, CA.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Fingar
authors.affiliation: Truven Health Analytics, Santa Barbara, CA.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Coffey
authors.affiliation: RAND Corporation, Pittsburgh, PA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kandrack
authors.affiliation: Merchant Medicine, St. Paul, MN.
authors.forename: Tom
authors.initials: T
authors.lastname: Charland
authors.affiliation: RAND Corporation, Washington, DC.
authors.forename: Christine
authors.initials: C
authors.lastname: Eibner
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Anne
authors.initials: A
authors.lastname: Elixhauser
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Claudia
authors.initials: C
authors.lastname: Steiner
authors.affiliation: RAND Corporation, Boston, MA; Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Ateev
authors.initials: A
authors.lastname: Mehrotra
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005843:Geography; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D014481:United States