Health care utilization before and after an outpatient ED visit in older people

Carolyn Horney, Kenneth Schmader, Linda L. Sanders, Mitchell Heflin, Luna Ragsdale, Eleanor McConnell, Michael Brian Hocker, S. Nicole Hastings

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. Objectives: The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults. Methods: This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits. Results: Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P <.001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status. Conclusion: Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalAmerican Journal of Emergency Medicine
Volume30
Issue number1
DOIs
StatePublished - Jan 1 2012

Fingerprint

Patient Acceptance of Health Care
Hospital Emergency Service
Outpatients
Primary Care Physicians
Delivery of Health Care
Proportional Hazards Models

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Horney, C., Schmader, K., Sanders, L. L., Heflin, M., Ragsdale, L., McConnell, E., ... Hastings, S. N. (2012). Health care utilization before and after an outpatient ED visit in older people. American Journal of Emergency Medicine, 30(1), 135-142. https://doi.org/10.1016/j.ajem.2010.10.036

Health care utilization before and after an outpatient ED visit in older people. / Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L.; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael Brian; Hastings, S. Nicole.

In: American Journal of Emergency Medicine, Vol. 30, No. 1, 01.01.2012, p. 135-142.

Research output: Contribution to journalArticle

Horney, C, Schmader, K, Sanders, LL, Heflin, M, Ragsdale, L, McConnell, E, Hocker, MB & Hastings, SN 2012, 'Health care utilization before and after an outpatient ED visit in older people', American Journal of Emergency Medicine, vol. 30, no. 1, pp. 135-142. https://doi.org/10.1016/j.ajem.2010.10.036
Horney, Carolyn ; Schmader, Kenneth ; Sanders, Linda L. ; Heflin, Mitchell ; Ragsdale, Luna ; McConnell, Eleanor ; Hocker, Michael Brian ; Hastings, S. Nicole. / Health care utilization before and after an outpatient ED visit in older people. In: American Journal of Emergency Medicine. 2012 ; Vol. 30, No. 1. pp. 135-142.
@article{25951686790b4dd18eb7eeb5f44d0a2c,
title = "Health care utilization before and after an outpatient ED visit in older people",
abstract = "Background: Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. Objectives: The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults. Methods: This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits. Results: Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P <.001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95{\%} confidence interval, 1.15-4.21), in models adjusted for demographics and health status. Conclusion: Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals.",
author = "Carolyn Horney and Kenneth Schmader and Sanders, {Linda L.} and Mitchell Heflin and Luna Ragsdale and Eleanor McConnell and Hocker, {Michael Brian} and Hastings, {S. Nicole}",
year = "2012",
month = "1",
day = "1",
doi = "10.1016/j.ajem.2010.10.036",
language = "English (US)",
volume = "30",
pages = "135--142",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Health care utilization before and after an outpatient ED visit in older people

AU - Horney, Carolyn

AU - Schmader, Kenneth

AU - Sanders, Linda L.

AU - Heflin, Mitchell

AU - Ragsdale, Luna

AU - McConnell, Eleanor

AU - Hocker, Michael Brian

AU - Hastings, S. Nicole

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Background: Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. Objectives: The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults. Methods: This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits. Results: Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P <.001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status. Conclusion: Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals.

AB - Background: Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. Objectives: The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults. Methods: This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits. Results: Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P <.001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status. Conclusion: Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals.

UR - http://www.scopus.com/inward/record.url?scp=81755187727&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81755187727&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2010.10.036

DO - 10.1016/j.ajem.2010.10.036

M3 - Article

VL - 30

SP - 135

EP - 142

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

IS - 1

ER -