Factors Affecting Visits to the Emergency Department for Urgent and Nonurgent Ocular Conditions.
To determine the frequency of emergency department (ED) visits for nonurgent and urgent ocular conditions and risk factors associated with ED use for nonurgent and urgent ocular problems.



Retrospective, longitudinal cohort analysis.



All enrollees aged 21 years or older in a United States managed care network during 2001-2014.



We identified all enrollees visiting an ED for ocular conditions identified by International Classification of Diseases, billing codes. Diagnosis is well-described as urgent, nonurgent, or other. We assessed the frequency of ED visits for urgent and nonurgent ocular conditions and how they changed over time. Next, we performed multivariable Cox regression modeling to determine factors associated with visiting an ED for urgent or nonurgent ocular conditions.



Hazard ratios (HRs) with 95% confidence intervals (CIs) of visiting an ED for urgent or nonurgent ocular conditions.



Of the 11 160 833 enrollees eligible for this study, 376 680 (3.4%) had 1 or more ED visit for an eye-related problem over a mean ± standard deviation of 5.4±3.3 years' follow-up. Among these enrolled, 86 473 (23.0%) had 1 or more ED visits with a nonurgent ocular condition and 25 289 (6.7%) had at least 1 ED visit with an urgent ocular condition. Use of the ED for nonurgent ocular problems was associated with younger age (P < 0.0001 for all comparisons), black race or Latino ethnicity (P < 0.0001 for both), male sex (P < 0.0001), lower income (P < 0.0001 for all comparisons), and those who frequently sought treatment at an ED for nonophthalmologic medical problems in a given year (P < 0.0001). Enrollees with established eye care professionals had a 10% reduced hazard of visiting the ED for nonurgent ocular conditions (adjusted HR, 0.90; 95% CI, 0.88-0.92; P < 0.0001).



Nearly one-quarter of enrollees who visited the ED for an ocular problem received a diagnosis of a nonurgent condition. Better educating and incentivizing patients to seek care for nonurgent ocular diseases in an office-based setting could yield considerable cost savings without adversely affecting health outcomes and could allow EDs to better serve patients with more severe conditions.
Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan.
Brian C
BC
Stagg
Department of Medicine, University of California, San Francisco, San Francisco, California.
Muazzum M
MM
Shah
Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
Nidhi
N
Talwar
Department of Ophthalmology and Visual Sciences, Vanderbilt University, Nashville, Tennessee.
Dolly A
DA
Padovani-Claudio
Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Center for Eye Policy & Innovation, University of Michigan, Ann Arbor, Michigan.
Maria A
MA
Woodward
Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Center for Eye Policy & Innovation, University of Michigan, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan. Electronic address: jdstein@med.umich.edu.
Joshua D
JD
Stein
D000328:Adult; D016001:Confidence Intervals; D004630:Emergencies / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005128:Eye Diseases / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000639:trends*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology