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EDs Provide More Chronic Disease Management, Less Trauma Care

SAN FRANCISCO – The drama of trauma generally is occurring less often in emergency departments, as clinicians spend more of their time caring for complex, chronic conditions.

That’s according to a new study published recently in the journal Health Affairs. The review of visits to California EDs from 2005 to 2011, led by University of California San Francisco researchers, finds that the emergency department "visit rate" decreased by 0.7% during the study's timeframe, while the rate of ED visits for non-injury diagnoses rose 13.4%. The highest growth rate among non-injury diagnoses included gastrointestinal system diseases, nervous system disorders, and symptoms of abdominal pain.

"While many people think of the ED as simply a place to go when you have a car accident or some type of major trauma, it is increasingly the case that the emergency department is caring for complex medical patients," said lead author Renee Y. Hsia, MD, professor of emergency medicine at UCSF and director of health policy studies in the UCSF Department of Emergency Medicine.

"At the same time, as our population ages, we are seeing a significant rise in older patients with falls or other trauma," Hsia said. "The emergency department therefore plays a critical role in our health care system's ability to care for the acutely injured as well as complex disease."

The rate of ED visits for injuries rose more slowly than non-injury diagnoses among Medicaid beneficiaries and the privately insured, while the rate decreased among the uninsured, according to the point.

Medicare beneficiaries, however, had a similar percent growth for injury and non-injury diagnoses. Non-injury related diagnoses were more common among younger patients 5-44 years old than the older population 45 and older, who had more injury-related diagnoses.

The research illustrates the complexity of emergency care, Hsia said, and it may help policy makers and emergency care physicians to reshape the structure, staffing and funding of emergency departments.

Another finding in the study was that the rate of growth in mental health conditions as a primary diagnosis was significant among the uninsured, Medicare beneficiaries, and the privately insured.