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Report showcases EDs' central role in U.S. healthcare

Thursday June 13, 2013
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Hospital EDs play a growing role in the U.S. healthcare system, accounting for a rising proportion of hospital admissions and serving increasingly as an advanced diagnostic center for primary care physicians, according to a study.

While often targeted as the most expensive place to get medical care, EDs remain an important safety net for Americans who cannot get care elsewhere and may play a role in slowing the growth of healthcare costs, according to the study from the RAND Corporation, a nonprofit research organization.

EDs are responsible for about half of all hospital admissions in the United States, accounting for nearly all of the growth in hospital admissions experienced between 2003 and 2009.

Despite evidence that people with chronic conditions such as asthma and heart failure are visiting EDs more frequently, the number of hospital admissions for these conditions has remained flat. The researchers said that trend suggests EDs may help to prevent some avoidable hospital admissions.

"Use of hospital emergency departments is growing faster than the use of other parts of the American medical system," Art Kellermann, MD, MPH, the studyís senior author and a senior researcher at RAND, said in a news release. "While more can be done to reduce the number of unnecessary visits to emergency rooms, our research suggests emergency rooms can play a key role in limiting growth of preventable hospital admissions."

RAND was asked by the Emergency Medicine Action Fund, a consortium of emergency medicine physician organizations, to develop a more-complete picture of how hospital EDs contribute to the U.S. healthcare system.

Researchers reviewed recent studies published about the use of EDs, analyzed federal information about ED use and conducted a series of interviews with primary care physicians, hospital-based doctors and ED physicians.

The study found that while admissions to U.S. hospitals grew more slowly than the nationís overall population from 2003 and 2009, nearly all of the growth over the period was caused by a 17% increase in unscheduled admissions made from EDs. That growth more than offset a 10% drop in admission from doctorsí office and other outpatient settings.

The researchers said the findings suggest that office-based physicians are directing to EDs some patients they previously would have admitted to the hospital themselves.

The study also found that EDs increasingly support primary care providers by performing complex diagnostic workups that cannot be done in physician offices. In addition, EDs supplement primary care providers by handling overflow, after-hours cases and weekend demand for medical care.

The researchers found that most people who seek care in an ED do so because they perceive no viable alternative, not because it was convenient. The finding suggests efforts to reduce non-urgent visits to EDs should focus on assuring timely access to primary care and less-expensive forms of care, rather than blocking access to EDs, the researchers said.

"We believe there needs to be more effort to integrate the operations of emergency departments into both inpatient and outpatient care systems," Kristy Gonzalez Morganti, the studyís lead author and a policy researcher at RAND, said in the news release.

Ways to accomplish better integration include greater use of interconnected health information technology, better coordination of care and case management, and more collaborative approaches to medical practice.

The researchers said the widespread adoption of these and other practice innovations could generate savings by providing patients with better access to safe non-emergent care, which would minimize duplicative testing and avoid needless hospital admissions.

Access the report: www.rand.org/pubs/research_reports/RR280.html.


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