Dataset Information

Trends in the utilisation of emergency departments in California, 2005-2015: a retrospective analysis.

ABSTRACT:

Objective

To examine current trends in the characteristics of patients visiting California emergency departments (EDs) in order to better direct the allocation of acute care resources.

Design

A retrospective study.

Setting

We analysed ED utilisation trends between 2005 and 2015 in California using non-public patient data from California's Office of Statewide Health Planning and Development.

Participants

We included all ED visits in California from 2005 to 2015.

Primary and secondary outcome measures

We analysed ED visits and visit rates by age, sex, race/ethnicity, payer and urban/rural trends. We further examined age, sex, race/ethnicity and urban/rural trends within each payer group for a more granular picture of the patient population. Additionally, we looked at the proportion of patients admitted from the ED and distribution of diagnoses.

Results

Between 2005 and 2015, the annual number of ED visits increased from 10.2 to 14.2?million in California. ED visit rates increased by 27.8% (p<0.001), with the greatest increases among patients aged 5-19 (37.4%, p<0.001) and 45-64 years (41.1%, p<0.001), non-Hispanic Black and Hispanic patients (56.8% and 48.8%, p<0.001), the uninsured and Medicaid-insured (36.1%, p=0.002; 28.6%, p<0.001) and urban residents (28.3%, p<0.001). The proportion of ED visits resulting in hospitalisation decreased by 18.3%, with decreases across all payer groups.

Conclusions

Our findings reveal an increasing demand for emergency care and may reflect current limitations in accessing care in other parts of the healthcare system. Policymakers may need to recognise the increasingly vital role that EDs are playing in the provision of care and consider ways to incorporate this changing reality into the delivery of health services.

SUBMITTER: Hsia RY

PROVIDER: S-EPMC6059325 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Trends in the utilisation of emergency departments in California, 2005-2015: a retrospective analysis.

Hsia Renee Y RY Sabbagh Sarah H SH Guo Joanna J Nuckton Thomas J TJ Niedzwiecki Matthew J MJ

BMJ open 20180723 7

<h4>Objective</h4>To examine current trends in the characteristics of patients visiting California emergency departments (EDs) in order to better direct the allocation of acute care resources.<h4>Design</h4>A retrospective study.<h4>Setting</h4>We analysed ED utilisation trends between 2005 and 2015 in California using non-public patient data from California's Office of Statewide Health Planning and Development.<h4>Participants</h4>We included all ED visits in California from 2005 to 2015.<h4>Pr ...[more]

PMID: 30037870

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Project description:Introduction:We assess trends in opioid administration and prescribing from 2005-2015 in older adults in United States (U.S.) emergency departments (ED). Methods:We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) survey from 2005 to 2015. ED visits for painful conditions were selected and stratified by age (18-64, 65-74, 75-84, ? 85 years). We analyzed trends in opioid administration in the ED and prescribing at discharge to encounters ? 65 and assessed predictors of use using survey-weighted chi-square tests and logistic regression. Trends in the use of five commonly prescribed opioids were also explored. Results:Opioid administration in the ED and prescribing at discharge for encounters with patients ? 65 years fell overall, but not significantly. By contrast, opioid administration in the ED and prescribing at discharge significantly declined for adult encounters 18-64 by 20% and 32%, respectively. A similar proportion of adult encounters ? 65 were administered opioids in the ED as 18-64, but adult encounters ? 85 had the lowest rates of administration. A smaller proportion of adult encounters ? 65 years with painful conditions were prescribed opioids at discharge compared to <65. However, this age-related disparity in prescribing narrowed over the study period. There were shifts in the specific types of opioids administered and prescribed in adult encounters ? 65 years over the study period, with the most notable being a 76% increase in hydromorphone administration comparing 2005-06 to 2014-15. Conclusion:From 2005-15, 1 in 4 to 1 in 10 ED patients with painful conditions were administered or prescribed an opioid in U.S. EDs. Opioids prescribing increased from 2005-11 and then declined from 2012-15, more so among visits in the 18-64 age group compared to ? 65 years. Opioid administrating demonstrated a gradual rise and decline in all adult age groups. Age consistently appears to be an important consideration, where opioid prescribing declines with advancing age. Given the nationwide opioid crisis, ED providers should remain vigilant in limiting opioids, particularly in older adults who are at higher risk for adverse effects.

Project description:Importance:The use of opioids to treat pain in pediatric patients has been viewed as necessary; however, this practice has raised concerns regarding opioid abuse and the effects of opioid use. To effectively adjust policy regarding opioids in the pediatric population, prescribing patterns must be better understood. Objective:To evaluate opioid prescribing patterns in US pediatric patients and factors associated with opioid prescribing. Design, Setting, and Participants:This cross-sectional study used publicly available data from the National Hospital Ambulatory Medical Care Survey from January 1, 2006, to December 31, 2015. Analysis included the use of bivariate and multivariate models to evaluate factors associated with opioid prescribing. Practitioners from emergency departments throughout the United States were surveyed, and data were collected using a representative sample of visits to hospital emergency departments. The study analyzed all emergency department visits included in the National Hospital Ambulatory Medical Care Survey for patients younger than 18 years. All statistical analysis was completed in June of 2018 and updated upon receiving reviewer feedback in October of 2018. Exposures:Information regarding participants' medications was collected at time of visit. Participants who reported taking 1 or more opioids were identified. Main Outcomes and Measures:Evaluation of opioid prescribing patterns across demographic factors and pain diagnoses. Results:A total of 69?152 visits with patients younger than 18 years (32?727 female) were included, which were extrapolated by the National Hospital Ambulatory Medical Care Survey to represent 293?528?632 visits nationwide, with opioid use representing 21?276?831 (7.25%) of the extrapolated visits. Factors including geographic region, race, age, and payment method were associated with statistically significant differences in opioid prescribing. The Northeast reported an opioid prescribing rate of 4.69% (95% CI, 3.69%-5.70%) vs 8.84% (95% CI, 6.82%-10.86%) in the West (P?=?.004). White individuals were prescribed an opioid at 8.11% (95% CI, 7.23%-8.99%) of visits vs 5.31% (95% CI, 4.31%-6.32%) for nonwhite individuals (P?<?.001). Those aged 13 to 17 years were significantly more likely to receive opioid prescriptions (16.20%; 95% CI, 14.29%-18.12%) than those aged 3 to 12 years (6.59%; 95% CI, 5.75%-7.43%) or 0 to 2 years (1.70%; 95% CI, 1.42%-1.98%). Patients using Medicaid for payment were less likely to receive an opioid than those using private insurance (5.47%; 95% CI, 4.79%-6.15% vs 9.73%; 95% CI, 8.56%-10.90%). There was no significant difference in opioid prescription across sexes. Opioid prescribing rates decreased when comparing 2006 to 2010 with 2011 to 2015 (8.23% [95% CI, 6.75%-9.70%] vs 6.30% [95% CI, 5.44%-7.17%]; P?<?.001); however, opioid prescribing rates remained unchanged in specific pain diagnoses, including pelvic and back pain. Conclusions and Relevance:This research demonstrated an overall reduction in opioid use among pediatric patients from 2011 to 2015 compared with the previous 5 years; however, there appear to be variations in factors associated with opioid prescribing. The association of location, race, payment method, and pain diagnoses with rates of prescribing of opioids suggests areas of potential quality improvement and further research.

Project description:BackgroundLow birth weight (LBW) is a leading risk factor for infant morbidity and mortality in the United States. There are large disparities in the prevalence of LBW by race and ethnicity, especially between African American and White women. Despite extensive research, the practice of clinical and public health, and policies devoted to reducing the number of LBW infants, the prevalence of LBW has remained unacceptably and consistently high. There have been few detailed studies identifying the factors associated with LBW in California, which is home to a highly diverse population. The aim of this study is to investigate recent trends in the prevalence of LBW infants (measured as a percentage) and to identify risk factors and disparities associated with LBW in California.MethodsA retrospective cohort study included data on 5,267,519 births recorded in the California Birth Statistical Master Files for the period 2005-2014. These data included maternal characteristics, health behaviors, information on health insurance, prenatal care use, and parity. Logistic regression models identified significant risk factors associated with LBW. Using gestational age based on obstetric estimates (OA), small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) infants were identified for the periods 2007-2014.ResultsThe number of LBW infants declined, from 37,603 in 2005 to 33,447 in 2014. However, the prevalence of LBW did not change significantly (6.9% in 2005 to 6.7% in 2014). The mean maternal age at first delivery increased from 25.7 years in 2005 to 27.2 years in 2014. The adjusted odds ratio showed that women aged 40 to 54 years were twice as likely to have an LBW infant as women in the 20 to 24 age group. African American women had a persistent 2.4-fold greater prevalence of having an LBW infant compared with white women. Maternal age was a significant risk factor for LBW regardless of maternal race and ethnicity or education level. During the period 2017-2014, 5.4% of the singleton births at 23-41 weeks based on OE of gestational age were SGA infants (preterm SGA + term SGA). While all the preterm SGA infants were LBW, both preterm AGA and term SGA infants had a higher prevalence of LBW.ConclusionsIn California, during the 10 years from 2005 to 2014, there was no significant decline in the prevalence of LBW. However, maternal age was a significant risk factor for LBW regardless of maternal race and ethnicity or education level. Therefore, there may be opportunities to reduce the prevalence of LBW by reducing disparities and improving birth outcomes for women of advanced maternal age.

Project description:ImportanceLittle is known about nonfatal firearm injuries in the United States, and national estimates based on emergency department samples may not be accurate.ObjectiveTo describe the incidence and distribution of nonfatal firearm injuries and estimate case fatality ratios (CFRs) for firearm injuries by external cause of injury code within California overall and by race/ethnicity, including an assessment of trends over time and geographic variation within the state.Design, setting, and participantsThis serial cross-sectional study used complete statewide data for firearm-related mortality, emergency department visits, and hospitalizations among California residents from January 1, 2005, through December 31, 2015, to analyze incidence, distribution, and CFRs of firearm injury. Data were analyzed from 2018 to 2019.ExposuresAll individuals in California with a firearm injury based on International Classification of Diseases, Ninth Revision or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were included.Main outcomes and measuresCounts and rates of nonfatal firearm injuries overall and stratified by external cause, sex, and race/ethnicity; total and clinical CFRs. Clinical CFR was calculated based on individuals treated in emergency departments or hospitals.ResultsOver the study period, there were 81 085 firearm-related emergency department visits and hospitalizations among individuals with a mean (SD) age of 27.5 (11.9) years, 72 567 (89.6%) of whom were men. Nonfatal firearm injuries in California decreased by 38.1% between 2005 and 2015, driven by a 46.4% decrease in assaultive injuries. Self-inflicted injuries and unintentional injuries remained relatively stable. The overall CFR for firearm injuries increased from 27.6% in 2005 to 32.2% in 2015 for a relative increase of 20.7%, while the clinical CFR remained stable between 7.0% and 9.0%.Conclusions and relevanceThese findings suggest that although the number of firearm injuries has decreased in California, the lethality of these injuries has not. Similar studies from other states could provide more information about these trends nationwide.

Dataset Information

Trends in the utilisation of emergency departments in California, 2005-2015: a retrospective analysis.

Objective

Design

Setting

Participants

Primary and secondary outcome measures

Results

Conclusions

Publications

Trends in the utilisation of emergency departments in California, 2005-2015: a retrospective analysis.

Similar Datasets

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