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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:
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Nonemergent – various data indicated
immediate medical care was not required within 12 hours
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Emergent/Primary Care Treatable –
treatment was required with 12 hours, but care could have been provided
effectively and safely in a primary care setting.
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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.
Contact:
Chris Burns, Communications Manager, 651-266-2537
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