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Emergency Departments See Rising Rate of Patients With Chronic Conditions, Lower Rate of Injuries

Findings could reshape structure, staffing, and funding of EDs

The rate of emergency department (ED) visits in California for non-injuries has risen while the rate of visits for injuries has dropped, according to a new study led by researchers at the University of California, San Francisco, that documents the increasing amount of care provided in EDs for complex, chronic conditions.

The research shows the growing importance of non-trauma cases in the ED, the authors said, and it provides an opportunity to better understand the health of people as well as shifting patterns of care, especially among vulnerable populations.

The findings were published in the April edition of Health Affairs.

The study, which looks at all visits to California EDs from 2005 to 2011, shows that the ED “visit rate” decreased by 0.7% during the study’s timeframe, whereas the rate of ED visits for non-injury diagnoses rose 13.4%. Among non-injury diagnoses, gastrointestinal diseases, nervous system disorders, and symptoms of abdominal pain were among the diagnoses with the highest growth in the rate of ED visits, the study found.

“While many people think of the ED as simply a place to go when you have a car accident or some type of major trauma, it is increasingly the case that the emergency department is caring for complex medical patients,” said lead author Renee Y. Hsia, MD. “At the same time, as our population ages, we are seeing a significant rise in older patients with falls or other trauma. The emergency department therefore plays a critical role in our health care system’s ability to care for the acutely injured as well as complex disease.”

While the rate of ED visits for injuries increased more slowly than that of non-injury diagnoses among Medicaid beneficiaries and the privately insured, the rate decreased among the uninsured, the authors found. Medicare beneficiaries, on the other hand, had a similar percent growth for injury and non-injury diagnoses. Younger patients (5 to 44 years old) experienced more non–injury-related diagnoses compared with the older population (45 years of age and older), who had more injury-related diagnoses.

The authors also found that the rate of growth in mental health conditions as a primary diagnosis was significant among the uninsured, Medicare beneficiaries, and the privately insured, showing that the ED is also serving as a place of care for patients with mental illness.

The new research shows the complexity of emergency care, Hsia said, and it may help policy makers and emergency-care physicians to reshape the structure, staffing, and funding of EDs.

Source: UCSF; April 6, 2015.

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