Impact of Urgent Care Openings on Emergency Department Visits to Two Academic Medical Centers Within an Integrated Health Care System.

Abstract:

STUDY OBJECTIVE:The effect of urgent cares on local emergency department (ED) patient volumes is presently unknown. In this paper, we aimed to assess the change in low-acuity ED utilization at 2 academic medical centers in relation to patient proximity to an affiliated urgent care. METHODS:We created a geospatial database of ED visits occurring between April 2016 and March 2018 to 2 academic medical centers in an integrated health care system, geocoded by patient home address. We used logistic regression to characterize the relationship between the likelihood of patients visiting the ED for a low-acuity condition, based on ED discharge diagnosis, and urgent care center proximity, defined as living within 1 mile of an open urgent care center, for each of the academic medical centers in the system, adjusting for spatial, temporal, and patient factors. RESULTS:We identified a statistically significant reduction in the likelihood of ED visits for low-acuity conditions by patients living within 1 mile of an urgent care center at 1 of the 2 academic medical centers, with an adjusted odds ratio of 0.87 (95% confidence interval 0.78 to 0.98). There was, however, no statistically significant reduction at the other affiliated academic medical center. Further analysis showed a statistically significant temporal relationship between time since urgent care center opening and likelihood of a low-acuity ED visit, with approximately a 1% decrease in the odds of a low-acuity visit for every month that the proximal urgent care center was open (odds ratio 0.99; 95% confidence interval 0.985 to 0.997). CONCLUSION:Although further research is needed to assess the factors driving urgent care centers' variable influence on low-acuity ED use, these findings suggest that in similar settings urgent care center development may be an effective strategy for health systems hoping to decrease ED utilization for low-acuity conditions at academic medical centers.

journal_name

Ann Emerg Med

authors

Carlson LC,Raja AS,Dworkis DA,Lee J,Brown DFM,Samuels-Kalow M,Wilson M,Shapiro M,Kim J,Yun BJ

doi

10.1016/j.annemergmed.2019.06.024

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

382-391

issue

3

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(19)30534-7

journal_volume

75

pub_type

杂志文章
  • Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey.

    abstract:STUDY OBJECTIVE:Transgender, transsexual, or transitioned (trans) people have reported avoiding medical care because of negative experiences or fear of such experiences. The extent of trans-specific negative emergency department (ED) experiences, and of ED avoidance, has not been documented. METHODS:The Trans PULSE Pr...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2013.09.027

    authors: Bauer GR,Scheim AI,Deutsch MB,Massarella C

    更新日期:2014-06-01 00:00:00

  • Adverse Effects of Immune Checkpoint Therapy in Cancer Patients Visiting the Emergency Department of a Comprehensive Cancer Center.

    abstract:STUDY OBJECTIVE:Cancer immunotherapy is evolving rapidly and is transforming cancer care. During the last decade, immune checkpoint therapies have been developed to enhance the immune response; however, specific adverse effects related to autoimmunity are increasingly apparent. This study aims to fill the knowledge gap...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2018.04.019

    authors: El Majzoub I,Qdaisat A,Thein KZ,Win MA,Han MM,Jacobson K,Chaftari PS,Prejean M,Reyes-Gibby C,Yeung SJ

    更新日期:2019-01-01 00:00:00

  • Interposed abdominal compression-CPR: a case study in cardiac arrest research.

    abstract::When the abdomen is compressed manually in counterpoint to the rhythm of chest compression, in the performance of interposed abdominal compression-CPR, artificial circulation is approximately doubled in animal experiments and in electronic models of the circulatory system. These studies suggest that external manual co...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(05)80245-8

    authors: Babbs CF

    更新日期:1993-01-01 00:00:00

  • Use of Oral Contrast for Abdominal Computed Tomography in Children With Blunt Torso Trauma.

    abstract:STUDY OBJECTIVE:We compare test characteristics of abdominal computed tomography (CT) with and without oral contrast for identifying intra-abdominal injuries. METHODS:This was a planned subanalysis of a prospective, multicenter study of children (<18 years) with blunt torso trauma. Children imaged in the emergency dep...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.annemergmed.2015.01.014

    authors: Ellison AM,Quayle KS,Bonsu B,Garcia M,Blumberg S,Rogers A,Wootton-Gorges SL,Kerrey BT,Cook LJ,Cooper A,Kuppermann N,Holmes JF,Pediatric Emergency Care Applied Research Network (PECARN).,Pediatric Emergency Care Applied Research

    更新日期:2015-08-01 00:00:00

  • Management and Outcomes of Children With Nursemaid's Elbow.

    abstract:STUDY OBJECTIVE:We identify the incidence and predictors of missed fracture and characterize patterns of radiography performance in children with a diagnosis of radial head subluxation in the emergency department (ED) setting. METHODS:We queried the Pediatric Health Information System database for visits by children y...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2020.09.002

    authors: Genadry KC,Monuteaux MC,Neuman MI,Lipsett SC

    更新日期:2021-02-01 00:00:00

  • Effect of povidone-iodine and saline soaking on bacterial counts in acute, traumatic, contaminated wounds.

    abstract::It is common practice to soak acute traumatic wounds in dilute povidone-iodine solution before definitive wound cleaning and debridement. The effectiveness of soaking wounds is unknown. Using quantitative wound bacterial counts as a measure of efficacy, we compared wounds soaked in 1% povidone-iodine solution or in no...

    journal_title:Annals of emergency medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s0196-0644(05)82486-2

    authors: Lammers RL,Fourré M,Callaham ML,Boone T

    更新日期:1990-06-01 00:00:00

  • Development of New Methods to Assess the Outcomes of Emergency Care.

    abstract::This article provides information supporting the need for new outcome measures in emergency care. It also addresses the use of outcome measures in emergency care, the impact of emergency care, identification of at-risk groups, new approaches to measuring patient satisfaction, quality of life and cost-effectiveness, an...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:

    authors: Cairns CB,Garrison HG,Hedges JR,Schriger DL,Valenzuela TD

    更新日期:1998-02-01 00:00:00

  • Insurance Status and Access to Urgent Primary Care Follow-up After an Emergency Department Visit in 2016.

    abstract:STUDY OBJECTIVE:We examine the availability of follow-up appointments for emergency department (ED) patients without established primary care by insurance and clinical condition. METHODS:We used "secret shopper" methodology, employing 2 black men to telephone all 53 primary care practices in greater New Haven, posing ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2017.08.045

    authors: Chou SC,Deng Y,Smart J,Parwani V,Bernstein SL,Venkatesh AK

    更新日期:2018-04-01 00:00:00

  • Toxicity from the use of niacin to beat urine drug screening.

    abstract::Niacin (vitamin B3) is promoted for rapidly clearing the body of drugs of abuse, such as cocaine and cannabis, and is alleged to interfere with urine drug screening. We present 4 cases of such novel use associated with significant adverse effects. Two cases had isolated skin manifestations, whereas the other 2 present...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2007.01.014

    authors: Mittal MK,Florin T,Perrone J,Delgado JH,Osterhoudt KC

    更新日期:2007-11-01 00:00:00

  • Insulin improves survival in a canine model of acute beta-blocker toxicity.

    abstract:STUDY OBJECTIVE:To compare the efficacy of a novel antidote, insulin, with standard treatments, glucagon and epinephrine, in a canine model of acute beta-blocker toxicity. METHODS:Anesthetized dogs were fitted with instruments by means of thoracotomy and vascular cutdown for multiple cardiodynamic, hemodynamic, metabo...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(97)70196-3

    authors: Kerns W 2nd,Schroeder D,Williams C,Tomaszewski C,Raymond R

    更新日期:1997-06-01 00:00:00

  • Should payment policy be changed to allow a wider range of EMS transport options?

    abstract::The Institute of Medicine and other national organizations have asserted that current payment policies strongly discourage emergency medical services (EMS) providers from transporting selected patients who call 911 to non-ED settings (eg, primary care clinics, mental health centers, dialysis centers) or from treating ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2013.09.025

    authors: Morganti KG,Alpert A,Margolis G,Wasserman J,Kellermann AL

    更新日期:2014-05-01 00:00:00

  • Noncardiogenic pulmonary edema following hydrochlorothiazide ingestion.

    abstract::A 57-year-old woman presented in severe respiratory distress 30 minutes after ingesting hydrochlorothiazide. Pulmonary edema was evident clinically and radiographically. A noncardiogenic etiology was suggested by the lack of jugular venous distention, S3 gallop, or pedal edema, and the presence of a normal cardiac sil...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(87)80531-0

    authors: Klein MD

    更新日期:1987-08-01 00:00:00

  • Derivation of a decision rule for the use of radiography in acute knee injuries.

    abstract:STUDY OBJECTIVE:To derive a highly sensitive decision rule for the selective use of radiography in acute knee injuries. DESIGN:Prospectively administered survey. SETTING:Emergency departments of two university hospitals. PARTICIPANTS:Convenience sample of 1,047 adults with acute knee injuries. RESULTS:Attending eme...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(95)70106-0

    authors: Stiell IG,Greenberg GH,Wells GA,McKnight RD,Cwinn AA,Cacciotti T,McDowell I,Smith NA

    更新日期:1995-10-01 00:00:00

  • Telephone follow-up after the emergency department visit: experience with acute asthma.

    abstract:STUDY OBJECTIVE:This study explored how a variety of demographic and illness-related factors were associated with telephone follow-up among patients visiting the emergency department for acute asthma. METHODS:We performed a prospective cohort study as part of the Multicenter Airway Research Collaboration (MARC). The s...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/S0196-0644(00)70027-8

    authors: Boudreaux ED,Clark S,Camargo CA Jr,MARC Investigators.

    更新日期:2000-06-01 00:00:00

  • Sequential treatment of a simple pneumothorax.

    abstract::In a prospective investigation of isolated simple pneumothorax, the treatment of 35 patients with a total of 37 pneumothoraces was studied. A standardized sequential treatment approach was followed for evacuation of the pneumothorax and maintenance of lung reexpansion. The protocol involved catheter placement using a ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(88)80676-0

    authors: Vallee P,Sullivan M,Richardson H,Bivins B,Tomlanovich M

    更新日期:1988-09-01 00:00:00

  • Determination of cerebral cortical blood flow: a thermal technique.

    abstract::A mathematical model for tissue thermodilution was developed to study cerebral cortical perfusion before and after controlled perfusion arrest. Cerebral cortical perfusion rates are readily determined by this method. A thermistor was introduced into the subdural space and secured in direct contact with the frontal cor...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(83)80123-1

    authors: Hoehner PJ,Krause GS,White BC,Gadzinski DS

    更新日期:1983-01-01 00:00:00

  • The cardiovascular effects of cocaine.

    abstract::Cocaine use and abuse continue to overwhelm urban economic, social, and health care systems. Patients frequently present to the emergency department with life-threatening manifestations of cocaine use, including trauma, acquired immune deficiency syndrome, psychomotor agitation, and cardiovascular collapse. Adequate t...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章,评审

    doi:10.1016/s0196-0644(05)81217-x

    authors: Goldfrank LR,Hoffman RS

    更新日期:1991-02-01 00:00:00

  • Central pulmonary embolism with normal ventilation/perfusion scan-diagnosis by nuclear pulmonary artery flow studies.

    abstract::Pulmonary embolism, although uncommon in children, occurs in as many as 104 per 100,000 pediatric patients. Undiagnosed and untreated pulmonary embolism has a high mortality rate; thus, a high index of clinical suspicion and reliable diagnostic modalities are necessary to ensure prompt and accurate diagnosis. We repor...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(05)81131-x

    authors: Hackbarth R,Kuhns L,Sarnaik A

    更新日期:1991-01-01 00:00:00

  • MAM-2201 (analytically confirmed) intoxication after "Synthacaine" consumption.

    abstract::Excitatory behavior, xerostomia, chest pain, severe dyspnea, tachycardia (150 beats/min), and mild hypertension (160/80 mm Hg) without ECG abnormalities were observed in a 20-year-old subject 6 hours after nasal insufflation (snorting) of a "legally" obtained white powdered substance sold as Synthacaine. A serum sampl...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2014.01.007

    authors: Lonati D,Buscaglia E,Papa P,Valli A,Coccini T,Giampreti A,Petrolini VM,Vecchio S,Serpelloni G,Locatelli CA

    更新日期:2014-12-01 00:00:00

  • Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes.

    abstract:STUDY OBJECTIVE:Coronary computed tomographic (CT) angiography has excellent performance characteristics relative to coronary angiography and exercise or pharmacologic stress testing. We hypothesize that coronary CT angiography can identify a cohort of emergency department (ED) patients with a potential acute coronary ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2008.09.025

    authors: Hollander JE,Chang AM,Shofer FS,McCusker CM,Baxt WG,Litt HI

    更新日期:2009-03-01 00:00:00

  • Trends in training: focus on emergency medicine.

    abstract::A research project was developed to study the process of professional socialization in graduate medical education by describing and analyzing the development of emergency medicine residencies in comparison to those of surgery and internal medicine. Based on the assumption that residency programs have a profound impact...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(80)80332-5

    authors: Anwar RA

    更新日期:1980-02-01 00:00:00

  • Response of consultants to the emergency department: a preliminary report.

    abstract:STUDY OBJECTIVE:To determine the timeliness of response of consultants called to evaluate patients in the emergency department of a community hospital. METHODS:Consultation requests from an ED located in a medium-sized community hospital were studied for a 1-month period. Data collected included name and specialty of ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(98)70035-6

    authors: Vosk A

    更新日期:1998-11-01 00:00:00

  • Preliminary program evaluation of emergency department HIV prevention counseling.

    abstract:OBJECTIVE:Controversy surrounds the linkage of prevention counseling with emergency department (ED)-based HIV testing. Further, the effectiveness and feasibility of prevention counseling in the ED setting is unknown. We investigate these issues by conducting a preliminarily exploration of several related aspects of our...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2011.03.036

    authors: Sitlinger AP,Lindsell CJ,Ruffner AH,Wayne DB,Hart KW,Trott AT,Fichtenbaum CJ,Lyons MS

    更新日期:2011-07-01 00:00:00

  • Retroperitoneal hemorrhage presenting as a ruptured ectopic pregnancy.

    abstract::A young woman presented with acute abdominal pain, anemia, and a positive pregnancy test. At surgery a large retroperitoneal hematoma secondary to a ruptured right kidney was found. Pathological examination revealed a hematogenic necrosis of a choriocarcinoma of the kidney. The patient tolerated subsequent chemotherap...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(87)80432-8

    authors: Plaus WJ

    更新日期:1987-12-01 00:00:00

  • Use of a Supraglottic Airway to Relieve Ventilation-Impeding Gastric Insufflation During Emergency Airway Management in an Infant.

    abstract::Positive-pressure bag-valve-mask ventilation during emergency airway management often results in significant gastric insufflation, which may impede adequate ventilation and oxygenation. Current-generation supraglottic airways have beneficial features, such as channels for gastric decompression while ventilation is ong...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/j.annemergmed.2016.03.016

    authors: Dodd KW,Strobel AM,Driver BE,Reardon RF

    更新日期:2016-10-01 00:00:00

  • The prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis in victims of sexual assault.

    abstract::The prevalence of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in 232 sexual assault victims who presented for examinations between August 1, 1987, and July 31, 1988, was determined. Results are reported for cervical, rectal, and oropharyngeal NG cultures and for cervical and rectal CT smears. Results fro...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(05)82197-3

    authors: Sturm JT,Carr ME,Luxenberg MG,Swoyer JK,Cicero JJ

    更新日期:1990-05-01 00:00:00

  • Two separate unintentional fatalities with the same revolver.

    abstract::We report 2 deaths and 1 injury that resulted from 2 separate unintentional discharges of the same Ruger Blackhawk revolver. One discharge was a consequence of careless firearm handling combined with a slip during a decocking procedure unique to certain hammer-action firearms. The second discharge occurred when the fi...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1067/mem.2001.112251

    authors: Lee C,Nolte KB

    更新日期:2001-03-01 00:00:00

  • Safety and efficacy of diclofenac ophthalmic solution in the treatment of corneal abrasions.

    abstract:STUDY OBJECTIVE:To determine whether the use of diclofenac ophthalmic solution is a safe and effective analgesic in the treatment of traumatic corneal abrasions in the emergency department. METHODS:We conducted a prospective, randomized, double-blinded, placebo-controlled clinical trial. Consenting consecutive patient...

    journal_title:Annals of emergency medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s0196-0644(00)70132-6

    authors: Szucs PA,Nashed AH,Allegra JR,Eskin B

    更新日期:2000-02-01 00:00:00

  • Shoulder pain and pneumoperitoneum following a diving accident.

    abstract::We present the case of a diver who experienced the acute onset of shoulder pain after a rapid ascent. It was determined that the patient had decompression sickness ("the bends") of the right shoulder and pulmonary barotrauma resulting in secondary pneumoperitoneum. He underwent decompression, with prompt resolution of...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(87)80240-8

    authors: Schriger DL,Rosenberg G,Wilder RJ

    更新日期:1987-11-01 00:00:00

  • Parents as direct contributors to the medical record: validation of their electronic input.

    abstract:STUDY OBJECTIVES:We assessed the validity and completeness of data in the past medical history (PMH) obtained electronically from parents and examined effects of the human-computer interface and sociodemographic variables on electronic parental report. METHODS:We compared parents' electronic report of PMH data with a ...

    journal_title:Annals of emergency medicine

    pub_type: 杂志文章

    doi:10.1016/s0196-0644(00)70052-7

    authors: Porter SC,Silvia MT,Fleisher GR,Kohane IS,Homer CJ,Mandl KD

    更新日期:2000-04-01 00:00:00