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ED VISITS: Comparing utilization in urban and rural areas

Changes in emergency department utilization rates from 2005 to 2016 in urban versus rural areas were studied based on data from the National Hospital Ambulatory Medical Care Survey.  The data used in the analysis are representative of the nation as a whole.  Here are the changes in visits per 100 population over the time period studied:

  • Rural areas: 36.5 visits/100 population (2005) to 64.5 visits/100 population (2016)
  • Urban areas: 40.2 visits/100 population (2005) to 42.8 visits/100 population (2016)

Reasons for the larger growth in the utilization rate per 100 population in rural areas are discussed.

Source: Greenwood-Ericksen, M.D., and Kocher, K. (2019, April 12). Trends in emergency department use by rural and urban populations in the United States. JAMA Network Open, 2(4). Full text here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730472  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

OPIOIDS: Neonatal abstinence syndrome treatment

The national incidence of NAS [neonatal abstinence syndrome] increased from 3.4 to 5.8 per 1,000 hospital births between 2009 and 2012…”

Babies born to mothers who have taken opiates may experience withdrawal symptoms after they are born.  In Kentucky, care for these newborns is usually provided in the neonatal intensive care unit.  In 2014, a task force was convened to develop a best practice treatment protocol.  This study, done at the University of Louisville Hospital, evaluated this new protocol for babies carried to term, finding a decrease in the number of days that the infants needed morphine therapy and a decrease in the need for adjunctive pharmacologic therapy.  Length of stay was shortened by 9 days and hospital charges were about $27,000 lower per patient.

Source: Devlin, L.A., Lau, T., and Radmacher, P.G. (2017, October 10). Frontiers in Pediatrics. 5(216).  Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641300/pdf/fped-05-00216.pdf

An All-Payer View of Hospital Discharge to Postacute Care

How many hospital patients are discharged to post acute care? According to a new report from the Agency for Healthcare Research and Quality, nearly 8 million hospital inpatients — 22.3% of all hospital discharges in 2013 — required continued post acute care, such as skilled nursing, rehabilitation, home care, or palliative care. Home health agencies accounted for 50% of the discharges to post acute care, while another 40% were for skilled nursing.

Medicare patients had the highest rate of hospital discharges going to post acute care — 41.7%. Total hip/knee replacement was the most common condition/procedure for post acute care [PAC]. Over 70% of all total hip/knee replacement patients went to PAC, and they accounted for nearly 10% of all discharges to PAC.

Hospital stays were nearly twice as long and costly for discharges to post acute care when compared to routine discharges.

Source: Tian W. An all-payer view of hospital discharge to postacute care, 2013. HCUP [Healthcare Cost and Utilization Project] Statistical Brief #205, May 2016. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb205-Hospital-Discharge-Postacute-Care.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Reasons for Emergency Room Use Among Adults

A new report from the CDC’s National Center for Health Statistics examines the reasons adults under age 65 used the emergency room. Here are some highlights:

  • Nearly 20% of adults use the emergency room at least once each year, a rate that has held steady over the last decade.
  • For those using the ER, 77% visited for the seriousness of a medical problem while 12% went to the ER because the doctor’s office was not open and 7% lacked access to another provider.
  • Adults with Medicaid coverage were more likely to visit than the privately insured or uninsured.
  • Few changes in ER utilization occurred between 2013 and 2014, immediately before and after implementation of the Affordable Care Act’s main health coverage provisions when 7.9 million adults aged 18–64 gained health insurance.

The report includes further analyses by patient age, gender, race/ethnicity, insurance status, and urban or rural residence.

Source: Gindi R and others. Reasons for emergency room use among U.S. adults aged 18-64: National Health Interview Survey, 2013 and 2014. National Health Statistics Report, no. 90, Feb. 18, 2016. http://www.cdc.gov/nchs/data/nhsr/nhsr090.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Hospitalizations Involving Mental and Substance Use Disorders Among Adults

According to a recent report from the Agency for Healthcare Research and Quality, 8.6 million hospitalizations involved at least one mental or substance abuse disorder in 2012, accounting for nearly a third of all inpatient stays. However, mental/substance abuse discorders were the primary reason for 1.8 million or 6.7% of all inpatient stays.

Mood disorders were the most common primary diagnosis for mental disorders, while alcohol-related disorders were the most frequent substance abuse diagnosis. Nearly 14% of those with a primary mental or substance abuse diagnosis were uninsured. Medicare and Medicaid covered 56% of all primary mental/substance abuse hospitalizations.

Source: Heslin KC and others. Hospitalizations involving mental and substance use disorders among adults, 2012. HCUP [Healthcare Cost and Utilization Project] Statistical Brief, no. 191, June 2015. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb191-Hospitalization-Mental-Substance-Use-Disorders-2012.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Trends in Potentially Preventable Hospital Admissions and Emergency Department Visits

From 2000 to 2012, the rate of potentially preventable hospitalizations among adults decreased by 19%, according to a new analysis from the Agency for Healthcare Research and Quality. Some of that decrease could be part of an overall trend in fewer hospital inpatient admissions. The decline was more prevalent for acute conditions [25%] than from chronic ones [14%].

However, outpatient emergency department use grew by 11% over the same period, rising from an ED visit rate of 235.0 per 10,000 population in 2008 to 261.8 rate in 2012.

Source: Fingar KR and others. Trends in potentially preventable inpatient hospital admissions and emergency department visits. HCUP [Healthcare Cost and Utilization Project] Statistical Brief, no. 195, Nov. 2105. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb195-Potentially-Preventable-Hospitalizations.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Distribution and Frequency of Hospital Stays in 2014 by Patient Characteristics

According to newly released data from the National Center for Health Statistics, 92.9% of the national population had no hospital stays in 2014. Another 5.5% had one hospital stay during the year, 1.0% had two stays, and 0.7% had three or more stays.

Further data is also available by gender, age, race/ethnicity, educational level, family income, poverty status, health insurance coverage, place of residence [urban/rural] and geographic region of the U.S.

Source: Table P-10. Number of overnight hospital stays during the past 12 months, by selected characteristics: United States, 2014. In: Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2014 Web Tables. National Center for Health Statistics, Dec. 2015. http://www.cdc.gov/nchs/nhis/SHS/tables.htm Direct link to Table P-10: http://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2014_SHS_Table_P-10.pdf

Posted by AHA Resource Center (312) 422-2050 rc@aha.org