Health care utilization before and after an outpatient ED visit in older people
Open accessAbstract
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.
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The association between high risk of recurrent ED use and high family physician use has been noted previously in other populations.
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From Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study (2023) · cites this paper as [40]
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Dufour, I., Chouinard, M.-C., Dubuc, N., Beaudin, J., Lafontaine, S., & Hudon, C. (2019) · BMC Geriatrics · doi:10.1186/s12877-019-1197-9 · Cited by 128 · see citing works
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- Authors
- Horney, C., Schmader, K., Sanders, L. L., Heflin, M., Ragsdale, L., McConnell, E., Hocker, M., & Hastings, S. N.
- Affiliations
- Duke Medical Center (US)
- Duke University (US)
- Durham VA Medical Center (US)
- Corresponding author
- Horney, Carolyn
- Hastings, S. Nicole
- Venue
- The American Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2012-01
- Volume
- 30
- Issue
- 1
- Pages
- 135-142
- ISSN
- 0735-6757 (ISSN-L)
- PMC
- PMC3136637
- OpenAlex
- W2068021510
- Cited by
- 21
- References
- 39
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 1 · 2015: 2 · 2014: 6 · 2013: 2
- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs (RCD 06-019)
- National Center for Research Resources (UL1RR024128)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- emergency department utilization, older adults, health care utilization, primary care visits, specialist visits, repeat emergency department visits, hospitalization, health care access, care fragmentation
- MeSH terms
- Aged, Delivery of Health Care, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Retrospective Studies, Severity of Illness Index, Chi-Square Distribution, Proportional Hazards Models, Statistics, Nonparametric
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