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EDs Play an Increasingly Outsized Role in Providing US Healthcare

It’s not just your imagination. Emergency departments (EDs) are carrying an increasingly heavy burden in providing healthcare to Americans.

A study published recently in the International Journal of Health Services found that 47.7% of the medical care delivered in the United States occurred in EDs, with the percentage rising progressively between 1996 and 2010.

“I was stunned by the results. This really helps us better understand healthcare in this country. This research underscores the fact that emergency departments are critical to our nation's healthcare delivery system,” said David Marcozzi, MD, an associate professor in the University of Maryland School of Medicine and co-director of the UMSOM Program in Health Disparities and Population Health. “Patients seek care in emergency departments for many reasons. The data might suggest that emergency care provides the type of care that individuals actually want or need, 24 hours a day.”

Yet, study authors point out, the outsized role of EDs in providing healthcare is often overlooked. For example, they note, the focus on the use of primary care and the delivery of care through patient-centered homes, managed care resources, and accountable care organizations rarely takes emergency care into consideration.

The researchers employed the National Ambulatory Medical Care Survey and National Hospital Discharge Survey databases to determine that, over the 14-year period of the study, more than 3.5 billion healthcare contacts occurred, with emergency care visits increasing by nearly 44%. At the same time, outpatient visits made up nearly 38%, while 15% involved inpatient care.

In 2010, the most recent year of the study, nearly 130 million ED visits were recorded vs. 101 million outpatient visits and nearly 39 million inpatient visits.

Study authors found that ED visits were more likely for African-American patients compared to patients in other racial groups — in 2010, those patients used the ED nearly 54% of the time, in general, and up to 59% for African-Americans living in urban areas. Higher rates also occurred for patients less likely to have health insurance, according to the report.

In addition, use of emergency care varied based on U.S. region. While 39% of all healthcare visits were to EDs in the Northeast, that percentage was more than 50% in both the South and West.

Increasing percentages of overall emergency room use occurred in African-Americans, Medicare and Medicaid beneficiaries, residents of the South and West, and women, the study notes.

Marcozzi suggested the solution might not be to reduce ED visits, but instead to better connect them to the continuum of care in the larger healthcare system.

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