There is some belief that Emergency Departments are being used for non-emergency medical care. In particular, do Medicaid recipients and uninsured patients overutilize ED for services better provided in other settings" In two studies conducted at Oregon Health and Science University, to be presented at the 2007 Society for Academic Emergency Medicine (SAEM) Annual Meeting, researchers have investigated some common assumptions about ED use and found some surprising results.
To analyze ED usage, a research tool called the Emergency Department Algorithm (EDA) has been developed that attempts to categorize all ED visits into four categories: non-emergency; emergency, primary care treatable; emergency, needing ED, but potentially avoidable; and emergency, needing ED, not avoidable. This algorithm was not designed to triage patients away from an ED or to deny payment or punish patients. Rather, it was designed to help understand access to care, because patients with worse access to care outside the ED may be more likely to use EDs for conditions in the first three categories. Research conducted by Robert A. Lowe, MD, MPH, and Rochelle Fu, PhD, at the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University concluded that this methodology although promising needs further refinement before it can be validated.
Many discussions of ED usage have centered on inappropriate or non-urgent use, use by Medicaid enrollees, and the generation of large and unnecessary costs. According to Dr. Lowe, None of this is true. The concept of inappropriate visits is nave. Problems with determining which visits are appropriate have led to estimates from 11% to 82%. This illustrates the pitfalls of attempting to identify inappropriate ED use for triage or reimbursement purposes.
In a related presentation, Daniel A. Handel, MD, MPH, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, studie
Contact: Linda Gruner
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