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Case Mix Differences in Freestanding vs. Hospital-based EDs

Location isn’t the only difference between hospital-based and freestanding EDs, according to information from a report that compared clinical characteristics for adult visits with these facilities.

Researchers gathered electronic health records on adult ED visits from July 1, 2014, to June 30, 2015, from three freestanding EDs and one level I trauma tertiary care hospital-based ED. Investigators studied 55,909 hospital-based ED visits and 44,108 freestanding ED visits.

Results indicate that the freestanding ED patients tended to include a slightly higher percentage of women compared with hospital-based EDs (61% vs. 57%). Freestanding ED patients also were more likely to be white (86% vs. 60%) and employed (67% vs. 49%).

Freestanding ED visits were more likely to be covered by private insurance compared with hospital-based EDs (43% vs. 20%) and less likely to be covered by either Medicaid (25% vs. 42%) or Medicare (23% vs. 30%).

Researchers did discover similarities between the two facilities regarding the top three presenting conditions: gastrointestinal (19% hospital-based ED vs. 18% freestanding ED), cardiorespiratory (18% vs. 16%), and injury pain swelling of extremity (14% vs. 17%).

Freestanding EDs logged a higher percentage of visits for injury or poisoning and for respiratory ailments, while hospital-based EDs showed a higher percentage of visits for circulatory system diseases and mental illness. Also, the rate of hospital admissions was much higher at hospital-based EDs, which investigators attributed in part to difference in acuity.