Abstract:
BACKGROUND:Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals. OBJECTIVE:The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and contextual factors associated with such behavior. RESEARCH DESIGN:We used the 2011-2014 Healthcare Cost and Utilization Project State Emergency Department Databases data on all outpatient ED visits in New York, Massachusetts, and Florida. We studied all adult ED users with ≥5 visits in a year and defined multisite use as visits to ≥3 different sites. We estimated predictors of multisite use with multivariate logistic regressions. RESULTS:Across all 3 states, 1,033,626 frequent users accounted for 7,613,077 ED visits. Of frequent users, 25% were multisite users, accounting for 30% of the visits studied. Frequent users with at least 1 visit for mental health or substance use-related diagnosis were more likely to use multiple sites. Uninsured frequent users and those with public insurance were associated with less use of multiple EDs than those with private coverage while lacking consistent coverage by the same insurance within each year were associated with using multiple sites. CONCLUSIONS:Health policy interventions to reduce duplicative or unnecessary ED use should apply a population health perspective and engage multiple hospitals. Community-level preventive approaches and a stronger infrastructure for mental health and substance use are essential to mitigate multisite ED use.
journal_name
Med Carejournal_title
Medical careauthors
Giannouchos TV,Washburn DJ,Kum HC,Sage WM,Ohsfeldt RLdoi
10.1097/MLR.0000000000001228subject
Has Abstractpub_date
2020-02-01 00:00:00pages
137-145issue
2eissn
0025-7079issn
1537-1948journal_volume
58pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract::Survey data measuring outpatient health expenditure are evaluated for item nonresponse, measurement error, and bias. Item nonresponse is high for persons whose health care is financed through the public sector, but is otherwise manageable. Estimates of mean total and out-of-pocket physician and dental expenditure from...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197611000-00002
更新日期:1976-11-01 00:00:00
abstract:BACKGROUND:Although there are several studies of the human and system factors that influence the outcomes of cardiac surgery, it remains difficult to draw conclusions because many do not simultaneously adjust for the characteristics of patients, physicians, and institutions. The current study explores the associations ...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e3182a048af
更新日期:2013-12-01 00:00:00
abstract::In a longitudinal, prospective study of patient's decisions about influenza vaccination, the stability of attitudes about the flu and flu shots, the stability of flu shot decisions, and the relationship of attitude shifts to compliance were studied. In both 1981 and 1982 for 216 patients at high risk for complications...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198506000-00002
更新日期:1985-06-01 00:00:00
abstract:BACKGROUND:Young men who have sex with men (YMSM) have the highest rates of human immunodeficiency virus (HIV) infection in the United States. Decades into the HIV epidemic, the relationships that YMSM-serving health and social organizations have with one another has not been studied in depth. OBJECTIVES:The aim of th...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000595
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Emergency Department (ED) boarding threatens patient safety. It is unclear whether boarding differentially affects patients admitted to intensive care units (ICUs) versus non-ICU settings. RESEARCH DESIGN AND SUBJECTS:We performed a 2-hospital, 18-month, cross-sectional, observational, descriptive study of ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000902
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Although the Affordable Care Act has been successful in expanding Medicaid to >17 million people, insurance alone may not translate into access to health care. Even among the insured, substantial barriers to accessing services inhibit health care utilization. OBJECTIVES:We examined the effect of selected ba...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000644
更新日期:2017-03-01 00:00:00
abstract::The human immunodeficiency virus (HIV) epidemic and the prevalence of HIV-positive persons in the population has provoked marked anxiety among hospital staffs of acquiring nosocomially transmitted HIV infections. A national telephone survey of key staff in a sample of 561 acute-care hospitals was undertaken to describ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199102000-00001
更新日期:1991-02-01 00:00:00
abstract:INTRODUCTION:Screening hospital patients for falls risk is now a contentious component of geriatric care despite its widespread clinical use. The economic implications of using a falls risk screening approach to deliver an effective falls prevention intervention have not previously been examined. METHODS:This was a mu...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e318190ccc0
更新日期:2009-04-01 00:00:00
abstract::Geriatric rehabilitation is a multidisciplinary set of evaluative, diagnostic, and therapeutic interventions whose purpose is to restore functional ability or enhance residual functional capability in elderly people with disabling impairments. The Boston Working Group on Improving Health Care Outcomes Through Geriatri...
journal_title:Medical care
pub_type:
doi:10.1097/00005650-199706001-00003
更新日期:1997-06-01 00:00:00
abstract::The authors examined the effect of after-hours telephone access to physicians and physician access to computerized medical records on hospitalizations and emergency room (ER) visits in an inner-city, adult, general medicine clinic. Patients were randomly assigned to a control (C) and two study groups (S1 and S2). Pati...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-198501000-00003
更新日期:1985-01-01 00:00:00
abstract::Breast cancer is the most common neoplasm in North American women. The psychosocial impact of breast cancer has been extensively studied, and a number of investigators have attempted to characterize women who are at high risk for increased psychosocial morbidity. Although a detailed interview performed by a profession...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-199305000-00004
更新日期:1993-05-01 00:00:00
abstract::Disparities by economic status are observed in the health status and health outcomes of Medicare beneficiaries. For health services and health policy researchers, one barrier to addressing these disparities is the ability to use Medicare data to ascertain information about an individual's income level or poverty, beca...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000606
更新日期:2017-12-01 00:00:00
abstract::A national sample of both hospital administrators and hospital review chair-persons (the two adversarial providers in the hospital regulatory milieu) were surveyed and asked to estimate the degree and kind of unnecessary hospital utilization taking place both in the U.S. and at their own institution. Both groups indic...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198101000-00006
更新日期:1981-01-01 00:00:00
abstract:BACKGROUND:Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, TBIs substantially contribute to health care costs, which vary by severity. This is important to consider given the variability in recovery time by severity. RESEARCH DESIGN:This study quantifies the annual incr...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001511
更新日期:2021-01-28 00:00:00
abstract::Many health care system, including that of the Department of Veterans Affairs (VA), are facing dramatic changes as they adapt to state-level reform legislation and move into managed care environments. As new costing systems are designed and as researchers seek to conduct cost-effectiveness studies to guide health poli...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199603001-00008
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:Consumer concerns about the restrictions of managed care may lead to distrust. OBJECTIVES:To examine whether a community's level of gatekeeping activity is associated with an individual's trust in medical care. RESEARCH DESIGN:Cross-sectional cohort (N = 49,929). SUBJECTS:Participants in a nationally repr...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.MLR.0000062703.14190.61
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:Continuity of nursing care in hospitals remains poor and not prioritized, and we do not know whether discontinuous nursing care is negatively impacting patient outcomes. OBJECTIVES:This study aims to examine nursing care discontinuity and its effect on patient clinical condition over the course of acute hos...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000670
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:The decision to perform orthopedic surgery requires substantial discretion and judgment. Similar conditions have been associated with health care disparities in other fields, but the extent of racial and ethnic disparities in orthopedics is unknown. OBJECTIVE:To evaluate the quality of extant orthopedic lit...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/MLR.0000000000000177
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:Hospital discharge planning has been hampered by the lack of predictive models. OBJECTIVE:To develop predictive models for nonelective rehospitalization and postdischarge mortality suitable for use in commercially available electronic medical records (EMRs). DESIGN:Retrospective cohort study using split va...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000435
更新日期:2015-11-01 00:00:00
abstract:CONTEXT:Small studies suggest that the quality of healthcare provided to older patients needs improvement. However, measuring the quality of care for larger groups of older adults is difficult. OBJECTIVE:To measure the quality of care in a community-dwelling vulnerable geriatric population using administrative data to...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318127143e
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVES:Patient perceptions are increasingly used to measure quality of care in a diversity of health-care delivery settings. The goals of this article are to review the current use of patient perceptions and to review what is known about the sensitivity of patient perceptions for discerning variations in care acros...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-199711001-00007
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVE:To examine the association between registered nurse (RN) staffing and patient outcomes in acute care hospitals. STUDY SELECTION:Twenty-eight studies reported adjusted odds ratios of patient outcomes in categories of RN-to-patient ratio, and met inclusion criteria. Information was abstracted using a standardi...
journal_title:Medical care
pub_type: 杂志文章,meta分析,评审
doi:10.1097/MLR.0b013e3181468ca3
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVES:Studies of cancer recurrences and second primary tumors require information on outcome dates. Little is known about how well electronic health record-based algorithms can identify dates or how errors in dates can bias analyses. RESEARCH DESIGN:We assessed rule-based and model-fitting approaches to assign ev...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000352
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Electronic health record (EHR) databases contain vast amounts of information about patients. Machine learning techniques such as Boosting and support vector machine (SVM) can potentially identify patients at high risk for serious conditions, such as heart disease, from EHR data. However, these techniques hav...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181de9e17
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:The number of older patients enrolling in health maintenance organizations (HMOs) is increasing. Concerns have been raised that older patients may be targeted by HMOs for more stringent cost-containment mechanisms, including reduced access to expensive specialty care. OBJECTIVES:We investigated the relation...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199912000-00002
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVES:Although information technology (IT) may improve efficiency and quality of patient care, the adoption of clinical IT by physicians has been limited. This study investigates the relationships between physician practice revenue and use of clinical IT. RESEARCH DESIGN:We undertook a cross-sectional analysis of...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000241089.98461.e5
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Evidence that medical error is a systemic problem requiring systemic solutions continues to expand. Developing a "safety culture" is one potential strategy toward improving patient safety. A reliable and valid self-report measure of safety culture is needed that is both grounded in concrete behaviors and is ...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/01.mlr.0000244635.61178.7a
更新日期:2007-01-01 00:00:00
abstract::As part of a comprehensive evaluation of care received by enrollees in a prepaid community health care project, we studied the process of care for enrollees reported to have a urinary tract infection. The care given to 98 patients enrolled in a large prepaid group practice (PGP) and 69 patients seen by 45 physicians i...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197806000-00005
更新日期:1978-06-01 00:00:00
abstract:BACKGROUND:The intensity of end-of-life care varies substantially both within and between areas. Differing practice patterns of individual physicians are likely influenced by their peers. OBJECTIVE:To assess whether intensity of end-of-life care previously provided by a physician's peers influences patterns of care at...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001124
更新日期:2019-06-01 00:00:00
abstract::Issues that arise in the development of methods for measuring adequacy of physician performance (MAPP) are discussed. The comparative content validity, scorability, cost, and acceptability of four MAPP strategies are assessed using a sample of clinic-based physicians treating 30 patients with chronic obstructive pulmo...
journal_title:Medical care
pub_type: 临床试验,杂志文章
doi:
更新日期:1984-07-01 00:00:00