Study finds most emergency room visits potentially preventable

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Study finds most emergency room visits are potentially preventable

A study by Saint Paul – Ramsey County Public Health has found that timely and effective primary care could potentially prevent 77 percent of emergency room visits. The study of health data from 2010 – 2014 determined 360,000 emergency room visits by county residents could have potentially been avoided, with the opportunity for better preventive care and lower costs if the illnesses been handled by regular office visits.

The study is the first ever by a local health department in Minnesota to analyze emergency room data on this scale; few, if any, local public agencies across the country have analyzed emergency room data for an entire population in their jurisdiction.  Among the study’s other findings of Ramsey County residents:

  • Close to half (46 percent) of emergency room visits were made during regular business hours when primary care offices are open.
  • Emergency rooms are used for non-urgent/potentially preventable care by people of all ages, with children under age five having the highest rate of potentially preventable visits.
  • There is a strong correlation between income and the number of emergency room visits.
  • The number of potentially preventable emergency room visits increased among those covered by public insurance and Medicare, while visits decreased among the uninsured and those covered by group and individual plans.
  • Urinary tract infections, headaches, abdominal pain and ear infections were the top diagnoses for potentially preventable visits made by Ramsey County residents.

 “While patents receive quality care in emergency rooms, it’s not without extra expenses for the patients, the hospitals and insurers,” said Saint Paul – Ramsey County Public Health Director Anne Barry. “Most importantly, emergency room use is neither an equal substitute or an adequate replacement for regular primary care. Patients who access care through the emergency rooms gain few of the preventive benefits of primary care, further exacerbating health disparities.”

Current statistics on the cost difference between care received in an emergency room versus a primary care clinic are not readily available. A 2006 study estimated the average emergency room visit cost $580 more than a comparable office visit to a primary care clinic.

Barry said the study released this week is step one of a three-part process to assess, understand and take action to remove barriers and improve patient-centered care.  “With this study, we’ve identified what is happening, our next step is to understand why,” said Barry. “In part two of this study, we need to hear the patient perspective and learn directly from them what are the various reasons they chose emergency rooms instead of other care settings.” Barry said the final phase of the study will be to work with community partners and health care providers to develop recommendations on actions that can be taken in policy and practice to reduce potentially preventable emergency room visits.

About the Study

Ensuring access to health care services is one of ten essential services of local public health, and prevention is a foundational principle of the profession. The Ramsey County 2014 – 2018 Community Health Improvement Plan identifies Access to Health Services as a priority goal, and identifies the study of emergency room data as an action step to determine the use of preventive health services in the county.

For this study, computerized administrative data from emergency room payer claims for all Ramsey County residents was obtained from the Minnesota Hospital Association (MHA) for the years 2010-2014.  Data were examined for county residents receiving emergency room care anywhere in Minnesota, North and South Dakota and Iowa. Wisconsin does not have a data sharing agreement with MHA, thus visits by Ramsey County residents to Wisconsin hospitals were not included. The data describe each emergency room visit and includes the year, day of week, beginning hour of visit, hospital, patient age and gender, diagnosis, payment methods, and whether they were discharged or admitted to the hospital. The MHA data set is based on visits, and because individual patients were not identified and not factored out, it can include multiple visits by the same person.

The study examined each emergency room visit and used a common research tool to categorize each emergency visit into four categories:

  • Nonemergent – various data indicated immediate medical care was not required within 12 hours
  • Emergent/Primary Care Treatable – treatment was required with 12 hours, but care could have been provided effectively and safely in a primary care setting.
  • Emergent, ED Care Needed, Preventable/Avoidable – emergency room care was required, but could have potentially been prevented if timely and effective outpatient care had been received for an individual with a previous identified health condition.
  • Emergency, ED Care Needed, Not Preventable -- Emergency care was needed and outpatient care could not have prevented the condition.

A full copy of the Saint Paul – Ramsey County Public Health study is online. Saint Paul - Ramsey County Public Health is the local health department serving Saint Paul and Ramsey County, Minnesota.

Chris Burns, Communications Manager, 651-266-2537

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