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

2014 Health Care Cost and Utilization Report for Privately Insured

The Health Care Cost Institute is out with its annual report on health care spending and use for those covered by employer-sponsored health insurance. Here are some of the report’s findings:

• Growth in annual per capita spending has held fairly steady since 2011. Annual expenditures grew 3.4% in 2014.
• Prices increased for all health services. Acute inpatient admissions rose 4.6% per capita from 2013 to 2014.
• Spending on brand prescriptions jumped by $45 per capita in 2014, despite a nearly 16 percent decrease in use.
• No surprise here — per capita costs increased with age, ranging from $2660 for those aged 0-18 to $$9466 for pre-Medicare adults aged 55-64.
• In 2014 the average out-of-pocket expense for those covered by employee health plans increased $17 to $810 a year. Women’s out-of-pocket health costs were higher than for men: $927 compared to $690.
• Use of health services declined in all categories except for generic prescriptions.
• The volume of annual acute inpatient care admissions continued its decline, with an admission rate of 53 per 1000 individuals in 2014 compared to 59 per 1000 in 2010.

Source: 2014 Health care cost and utilization report. Health Care Cost Institute, Oct. 2015. http://www.healthcostinstitute.org/2014-health-care-cost-and-utilization-report

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

TRENDS: Outpatient utilization metrics have been going up

Health, United States, 2015 is available.  This is the latest in an annual compendium of statistics published by the federal government which is drawn from both government and nongovernment sources, including the American Hospital Association.  It’s a good place to start to look for historical trend statistics (usually at the national level) on topics related to health status and health care delivery.

Below are data from one table in this massive report.  The data below are authoritative national estimates, based on a sample survey, that were produced by the National Center for Health Statistics.

Why are utilization metrics expressed as “per 100 persons” or “per 1000 persons” interesting?  Because if you a health planner, you can take a geographical service area with a known population size and calculate the approximate number of physician office visits or hospital outpatient visits or emergency department visits that can be expected from that population in a twelve month period.  Doing a demand analysis would then go on to take into account the local competition and other factors, but national utilization estimates like this can be a helpful way to start.

PHYSICIAN OFFICE VISITS per 100 persons per year (age adjusted)

• 271  1995
• 304  2000
• 325  2010
• [not available] 2011

Note that this is consistently about 3 physician office visits per person per year.  Does that seem intuitively pleasing to you?  Did you go to see doctors three times last year?  Remember, too, that the above includes children and seniors.

HOSPITAL OUTPATIENT DEPARTMENT VISITS per 100 persons per year (age adjusted)

• 26  1995
• 31  2000
• 33  2010
• 40  2011

HOSPITAL EMERGENCY DEPARTMENT VISITS per 100 persons per year (age adjusted)

• 37  1995
• 40  2000
• 43  2010
• 45  2011

Source: Table 82, Visits to physician offices, hospital outpatient departments, and hospital emergency departments, by age, sex, and race: United States, selected years 1995-2011.  In U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. (2015). Health, United States, 2015. Retrieved from http://www.cdc.gov/nchs/hus.htm  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Utilization of Intensive Care Services

In 2011, 27% of hospitals stays included intensive care unit charges, and the ICU charges accounted for nearly half [48%] of total hospital charges. Critical care costs have been rising for years. Between 2002 and 2009, critical care stays grew 3 times faster than the rate of hospital stays and without any increase in illness severity. The reason for the greater ICU utilization is unclear, according to a new AHRQ report, but it’s likely to get more attention because of the costs involved.

The report is based on an analysis of adult ICU utilization in general medical and surgical hospitals in 29 states in 2011. Here are other highlights from the study:

• Hospital stays involving ICU care were 2.5 times more costly than other hospital stays.
• The highest rate of ICU use — over 93% — was for respiratory disease with ventilator support.
• Cardiac, respiratory, and neurologic conditions dominated types of stays with high ICU use.
• Major complications or co-morbidities were associated with greater use of ICUs.
• Greater ICU use was correlated with larger hospitals, large urban areas, for-profit hospitals, teaching hospitals, and hospitals with level I or II trauma centers.

Source: Barret ML and others. Utilization of intensive care services, 2011. HCUP Statistical Brief [Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project], no. 185, Dec. 2014. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb185-Hospital-Intensive-Care-Units-2011.pdf

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