Emergency Department Access

Emergency Department Access

Patient Perspectives on Accessing Acute Illness Care

Mary K. Finta, BA, BS, et al.

Older adults use the emergency department (ED) at high rates, including for illnesses that could be managed by their primary care providers (PCP). Policymakers have implemented barriers and incentives, often financial, to try to modify use patterns but with limited success. This study aims to understand the factors that influence older adults’ decision to obtain acute illness care from the ED rather than from their PCPs.

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Emergency Department Access

Prevalence of Homelessness in the Emergency Department Setting

Brett J. Feldman, MSPAS, PA-C, et al.

According to the National Alliance to End Homelessness, the national rate of homelessness has been cited as 17.7 homeless people/10,000 people in the general population, and 24.8 homeless veterans/10,000 veterans in the general population.

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Emergency Department Access

Access to In-Network Emergency Physicians and Emergency Departments Within Federally Qualified Health Plans in 2015

Volume 17, Issue 1, January 2016.
Stephen C. Dorner, MSc, et al.

Introduction: Under regulations established by the Affordable Care Act, insurance plans must meet
minimum standards in order to be sold through the federal Marketplace. These standards to become
a qualified health plan (QHP) include maintaining a provider network sufficient to assure access to
services. However, the complexity of emergency physician (EP) employment practices – in which
the EPs frequently serve as independent contractors of emergency departments, independently
establish insurance contracts, etc… – and regulations governing insurance repayment may hinder
the application of network adequacy standards to emergency medicine. As such, we hypothesized
the existence of QHPs without in-network access to EPs. The objective is to identify whether
there are QHPs without in-network access to EPs using information available through the federal
Marketplace and publicly available provider directories.
Results: In a national sample of Marketplace plans, we found that one in five provider networks
lacks identifiable in-network EPs. QHPs lacking EPs spanned nearly half (44%) of the 34 states
using the federal Marketplace.
Conclusion: Our data suggest that the present regulatory framework governing network adequacy
is not generalizable to emergency care, representing a missed opportunity to protect patient access
to in-network physicians. These findings and the current regulations governing insurance payment to
EPs dis-incentivize the creation of adequate physician networks, incentivize the practice of balance
billing, and shift the cost burden to patients.

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Emergency Department Access

Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation

Volume 17, Issue 1, January 2016.
Kohei Hasegawa, MD, MPH, et al.

frequent asthma exacerbations. However, there have been no recent multicenter efforts to examine
the relationship of insurance status – a proxy for socioeconomic status – with asthma severity and
management in adults. The objective is to investigate chronic and acute asthma management disparities
by insurance status among adults requiring emergency department (ED) treatment in the United States.
Methods: We conducted a multicenter chart review study (48 EDs in 23 U.S. states) on ED patients,
aged 18-54 years, with acute asthma between 2011 and 2012. Each site underwent training (lecture,
practice charts, certification) before reviewing randomly selected charts. We categorized patients
into three groups based on their primary health insurance: private, public, and no insurance.
Outcome measures were chronic asthma severity (as measured by ≥2 ED visits in one-year period)
and management prior to the index ED visit, acute asthma management in the ED, and prescription
at ED discharge.
Results: The analytic cohort comprised 1,928 ED patients with acute asthma. Among these, 33% had
private insurance, 40% had public insurance, and 27% had no insurance. Compared to patients with
private insurance, those with public insurance or no insurance were more likely to have ≥2 ED visits
during the preceding year (35%, 49%, and 45%, respectively; p<0.001). Despite the higher chronic
severity, those with no insurance were less likely to have guideline-recommended chronic asthma care
– i.e., lower use of inhaled corticosteroids (ICS [41%, 41%, and 29%; p<0.001]) and asthma specialist
care (9%, 10%, and 4%; p<0.001). By contrast, there were no significant differences in acute asthma
management in the ED – e.g., use of systemic corticosteroids (75%, 79%, and 78%; p=0.08) or initiation
of ICS at ED discharge (12%, 12%, and 14%; p=0.57) – by insurance status.
Conclusion: In this multicenter observational study of ED patients with acute asthma, we found
significant discrepancies in chronic asthma severity and management by insurance status. By
contrast, there were no differences in acute asthma management among the insurance groups.

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Emergency Department Access

Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department

Volume 16, Issue 4, July 2015.
Ashley Parks, MD, et al.

Availability of timely access to ambulatory care for semi-urgent medical concerns in
rural and suburban locales is unknown. Further distance to an emergency department (ED) may
require rural clinics to serve as surrogate EDs in their region, and make it more likely for these clinics
to offer timely appointments. We determined the availability of urgent (within 48 hours) access to
ambulatory care for non-established visiting patients, and assessed the effect of insurance and
ability to pay cash on a patient’s success in scheduling an appointment in rural and suburban
Eastern United States.

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Emergency Department Access

Who’s Boarding in the Psychiatric Emergency Service?

Volume 15, Issue 6, September 2014
Scott A. Simpson, MD, MPH et al.

When a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a “boarder.” The psychiatric emergency service (PES) has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described.

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Emergency Department Crowding is Associated with Reduced Satisfaction Scores in Patients Discharged from the Emergency Department

Introduction: Emergency department (ED) crowding has been shown to negatively impact patient outcomes. Few studies have addressed the effect of ED crowding on patient satisfaction. Our objective was to evaluate the impact of ED crowding on patient satisfaction in patients discharged from the ED.

Conclusion: Increased crowding, as measured by ED occupancy rate and EDWIN score, was significantly associated with reduced patient satisfaction. Although causative attribution was limited, our study suggested yet another negative impact resulting from ED crowding.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.