The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization

Introduction: Prevention quality indicators (PQI) are a set of measures used to characterize healthcare utilization for conditions identified as being potentially preventable with high quality ambulatory care. These indicators have recently been adapted for emergency department (ED) patient presenta...

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Autores principales:	Lucas C. Carlson, Kori S. Zachrison, Brian J. Yun, Gia Ciccolo, Benjamin A. White, Carlos A. Camargo Jr, Margaret E. Samuels-Kalow
Formato:	article
Lenguaje:	EN
Publicado:	eScholarship Publishing, University of California 2021
Materias:	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/6d0bb8af302e452b9cfa961d927ee3ea
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spelling	oai:doaj.org-article:6d0bb8af302e452b9cfa961d927ee3ea2021-11-17T15:19:27ZThe Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization1936-901810.5811/westjem.2021.5.50233https://doaj.org/article/6d0bb8af302e452b9cfa961d927ee3ea2021-09-01T00:00:00Zhttps://escholarship.org/uc/item/0f10n26whttps://doaj.org/toc/1936-9018Introduction: Prevention quality indicators (PQI) are a set of measures used to characterize healthcare utilization for conditions identified as being potentially preventable with high quality ambulatory care. These indicators have recently been adapted for emergency department (ED) patient presentations. In this study the authors sought to identify opportunities to potentially prevent emergency conditions and to strengthen systems of ambulatory care by analyzing patterns of ED utilization for PQI conditions. Methods: Using multivariable logistic regression, the authors analyzed the relationship of patient demographics and neighborhood-level socioeconomic indicators with ED utilization for PQI conditions based on ED visits at an urban, academic medical center in 2017. We also used multilevel modeling to assess the contribution of these variables to neighborhood-level variation in the likelihood of an ED visit for a PQI condition. Results: Of the included 98,522 visits, 17.5% were categorized as potentially preventable based on the ED PQI definition. On multivariate analysis, age < 18 years, Black race, and Medicare insurance had the strongest positive associations with PQI visits, with adjusted odds ratios (aOR) of 1.41 (95% confidence interval [CI], 1.29, 1.56), 1.40 (95% CI, 1.22, 1.61), and 1.40 (95% CI, 1.28, 1.54), respectively. All included neighborhood-level socioeconomic variables were significantly associated with PQI visit likelihood on univariable analysis; however; only level of education attainment and private car ownership remained significantly associated in the multivariable model, with aOR of 1.13 (95% CI, 1.10, 1.17) and 0.96 (95% CI, 0.93, 0.99) per quartile increase, respectively. This multilevel model demonstrated significant variation in PQI visit likelihood attributable to neighborhood, with interclass correlation decreasing from 5.92% (95% CI, 5.20, 6.73) in our unadjusted model to 4.12% (95% CI, 3.47, 4.87) in our fully adjusted model and median OR similarly decreasing from 1.54 to 1.43. Conclusion: Demographic and local socioeconomic factors were significantly associated with ED utilization for PQI conditions. Future public health efforts can bolster efforts to target underlying social drivers of health and support access to primary care for patients who are Black, Latino, pediatric, or Medicare-dependent to potentially prevent emergency conditions (and the need for emergency care). Further research is needed to explore other factors beyond demographics and socioeconomic characteristics driving spatial variation in ED PQI visit likelihood.Lucas C. CarlsonKori S. ZachrisonBrian J. YunGia CiccoloBenjamin A. WhiteCarlos A. Camargo JrMargaret E. Samuels-KaloweScholarship Publishing, University of CaliforniaarticleMedicineRMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENWestern Journal of Emergency Medicine, Vol 22, Iss 6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Lucas C. Carlson Kori S. Zachrison Brian J. Yun Gia Ciccolo Benjamin A. White Carlos A. Camargo Jr Margaret E. Samuels-Kalow The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization
description	Introduction: Prevention quality indicators (PQI) are a set of measures used to characterize healthcare utilization for conditions identified as being potentially preventable with high quality ambulatory care. These indicators have recently been adapted for emergency department (ED) patient presentations. In this study the authors sought to identify opportunities to potentially prevent emergency conditions and to strengthen systems of ambulatory care by analyzing patterns of ED utilization for PQI conditions. Methods: Using multivariable logistic regression, the authors analyzed the relationship of patient demographics and neighborhood-level socioeconomic indicators with ED utilization for PQI conditions based on ED visits at an urban, academic medical center in 2017. We also used multilevel modeling to assess the contribution of these variables to neighborhood-level variation in the likelihood of an ED visit for a PQI condition. Results: Of the included 98,522 visits, 17.5% were categorized as potentially preventable based on the ED PQI definition. On multivariate analysis, age < 18 years, Black race, and Medicare insurance had the strongest positive associations with PQI visits, with adjusted odds ratios (aOR) of 1.41 (95% confidence interval [CI], 1.29, 1.56), 1.40 (95% CI, 1.22, 1.61), and 1.40 (95% CI, 1.28, 1.54), respectively. All included neighborhood-level socioeconomic variables were significantly associated with PQI visit likelihood on univariable analysis; however; only level of education attainment and private car ownership remained significantly associated in the multivariable model, with aOR of 1.13 (95% CI, 1.10, 1.17) and 0.96 (95% CI, 0.93, 0.99) per quartile increase, respectively. This multilevel model demonstrated significant variation in PQI visit likelihood attributable to neighborhood, with interclass correlation decreasing from 5.92% (95% CI, 5.20, 6.73) in our unadjusted model to 4.12% (95% CI, 3.47, 4.87) in our fully adjusted model and median OR similarly decreasing from 1.54 to 1.43. Conclusion: Demographic and local socioeconomic factors were significantly associated with ED utilization for PQI conditions. Future public health efforts can bolster efforts to target underlying social drivers of health and support access to primary care for patients who are Black, Latino, pediatric, or Medicare-dependent to potentially prevent emergency conditions (and the need for emergency care). Further research is needed to explore other factors beyond demographics and socioeconomic characteristics driving spatial variation in ED PQI visit likelihood.
format	article
author	Lucas C. Carlson Kori S. Zachrison Brian J. Yun Gia Ciccolo Benjamin A. White Carlos A. Camargo Jr Margaret E. Samuels-Kalow
author_facet	Lucas C. Carlson Kori S. Zachrison Brian J. Yun Gia Ciccolo Benjamin A. White Carlos A. Camargo Jr Margaret E. Samuels-Kalow
author_sort	Lucas C. Carlson
title	The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization
title_short	The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization
title_full	The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization
title_fullStr	The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization
title_full_unstemmed	The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization
title_sort	association of demographic, socioeconomic, and geographic factors with potentially preventable emergency department utilization
publisher	eScholarship Publishing, University of California
publishDate	2021
url	https://doaj.org/article/6d0bb8af302e452b9cfa961d927ee3ea
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The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization

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