For many minority patients, the emergency department (ED) serves as a primaryhealthcare facility. Minorities represent more than half of the uninsured population(Cardelli & Chiapa, 2007). Although many uninsured patients utilize the ED for non-urgent care, privately insured patients do not frequent the ED for care (Khaliq &Broyles, 2006). Utilization of EDs is not based solely on race or ethnicity.Additional factors include:
income (Suruda, Burns, Knight, & Dean, 2005)
insurance status (Todd, Armon, Griggs, Poole, & Berman, 2006)
access to primary care (Cardelli & Chiapa, 2007)
cost of care (Baker & Baker, 1994)
The disparity in ED utilization is exacerbated by the cost of care being markedlymore expensive than the cost of care in a primary healthcare setting (Baker &Baker, 1994; Machlin, 2006; Newton, Keirns, Cunningham, Haywood, & Stanley,2008). The high cost of care places a financial strain on minority patients (Cheong,Feeley, & Servoss, 2007) who reportedly earn lower incomes than their Whitecounterparts (Boudreaux, Edmond, Clark, & Camargo, 2003). The existence of freeclinics helps to offset the financial burden for minorities seeking treatment in theED (Isaacs & Jellinek, 2007).
Is access to primary care the solution we have been searching for regarding emergencydepartment utilization differences between minority and non-minority patients?
Marquianna Griffin, MSPH; Stephen Notaro, PhD; I. Shevon Harvey, DrPH
Department of Community Health at University of Illinois at Urbana-Champaign
INTRODUCTION
Black, non-Hispanic patients had higher mean number visits to the ED (1.41)than Caucasian patients (1.04).
OBJECTIVE
METHODOLOGY
SELECTED RESULTS
CONCLUSIONS
LIMITATIONS
FUTURE RESEARCH RECOMMENDATIONS
1.Compare ED utilization between minority and non-minority patients
2.Identify which factors contribute to minority patients utilizing the ED in greaternumbers than their non-minority counterparts
3.Discuss accessible primary care as a solution for patients utilizing the ED fortheir healthcare needs
Demographic Information Form inquired about patients’ demographiccharacteristics and health service utilization (specific focus on ED utilization)
Sample
Data compiled between 2005 and 2007
Surveys were completed by first-time patients at the Champaign CountyChristian Health Center, a free health clinic in Champaign, IL (n=971)
Non-Hispanic Black/African American, non-Hispanic White/Caucasian,Hispanic, Other
Statistical analysis
The Statistical Package for Social Sciences (SPSS) was utilized to analyzethe data
A chi-square analysis, bivariate statistical analysis (ANOVA) and generalizedlinear model were utilized to analyze the data
Location
Race/ethnicity
χ 2, p
White
Black
Hispanic
37.72,p=0.000
Hospital
12.8%
11.4%
11.4%
Emergency Room
14.4%
16.4%
5.7%
Community Health Ctrs
12.2%
15.0%
28.6%
Other Healthcare
5.6%
8.2%
5.7%
Nowhere/Don’t Know
55.0%
49.1%
48.6%
Visits
Race/ethnicity
χ 2, p
White
Black
Hispanic
45.71,p=0.000
0 ED visits
61.0%
52.5%
81.7%
1 ED visit
18.8%
18.4%
11.8%
2 ED visits
9.5%
11.9%
4.3%
3 ED visits
4.0%
7.3%
2.2%
4 ED visits or more
6.7%
10.0%
0.0%
Race/ethnicity
Frequency
F, p
Mean
SD
5.88, p=0.001
White
1.04
2.62
Black
1.41
2.95
Hispanic
0.27
0.66
Race/ethnicity
Frequency
F, p
Mean
SD
3.07, p=0.027
White
$11,005.58
$10,702.00
Black
$8,050.00
$10,704.09
Hispanic
$10,044.55
$10,376.87
Characteristics of patients with high ED utilization were:
Minority (Black, non-Hispanic)
Lower income
Visits to the ED for non-urgent conditions
Residing in female-headed household
Black, non-Hispanic patients tend to earn lower incomes, reside in femaleheaded households, and visit the ED for non-urgent care in greater numbers incomparison to their White, non-Hispanic counterparts
Access to primary care can
Reduce the number of patients visiting the ED for their primary care
Potentially reduce the economic strain on the healthcare system resultingfrom low-income patients that incur ED cost for their primary care
The existence of free health clinics provides a primary healthcare alternative tothe ED
Self-reported data
Open-ended questions
Insurance coverage not collected on survey instrument
Number of Hispanic and “Other” patients relatively small
Future studies should collect data on healthcare utilization and insurancecoverage to determine if uninsured minorities frequent the ED because they lackinsurance coverage
If data is utilized in free clinic setting:
Questions should provide concrete responses for data analysis
Medical records should be utilized for diagnosis as opposed to self-reportedreason for visit
Research instrument should ask patients if they have insurance coverage
Analysis should study relationships between ED utilization and insurancecoverage
Higher percentages of Black, non-Hispanic patients reported they had 2 or morevisits to the ED within the previous year
16.4% of Black, non-Hispanic patients reported they would have soughttreatment in the ED for healthcare in the absence of CCCHC in comparison to14.4% of White, non-Hispanic patients
Hispanic and Black, non-Hispanic patients reported lower mean annual incomesthan White, non-Hispanic patients (see Table 4)
The majority of White and Black, non-Hispanic patients visited the ED for non-urgent care (67.7% and 76.3%, respectively), with Black, non-Hispanic patientsexhibiting a larger percentage for non-urgent care
Race/ethnicity
FemaleHead
Frequency
F, p (race/eth)
F, p (f head)
Mean
SD
5.48, p<0.001
1.54, p=0.216
White
Yes
1.09
2.62
No
0.89
1.98
Black
Yes
1.57
2.77
No
1.36
3.45
Hispanic
Yes
0.30
0.65
No
0.26
0.61
Table 1 - Mean Number of Visits to the ED within thePrevious Year
Table 5 - Mean Yearly Income
Black, non-Hispanic patients residing in female-headed householdsdemonstrated higher mean ED visits than White, non-Hispanic patients
Table 4 - Mean Number of ED Visits in Previous Year byFemale Head of Household
Table 2 - Percentage of Categorized Number of ED Visitsin Previous Year
Table 3 – Percentage for Location of Alternate Healthcare
SELECTED RESULTS cont.
Graph 1 - Urgency of ED Conditions (White, non-HispanicPatients)
Graph 2 - Urgency of ED Conditions (Black, non-HispanicPatients)
