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University of Maryland School of Medicine Study Finds That Nearly Half of U.S. Hospital-Associated Medical Care Comes From Emergency Rooms

| David Kohn

David Marcozzi, MD, MHS-CL, FACEP

Figures Are Even Higher For Minorities and Women

In the first study to quantify the contribution of emergency department care to overall U.S. health care, researchers at the University of Maryland School of Medicine (UMSOM) have found that nearly half of all US hospital-associated medical care is delivered by emergency departments. The paper highlights the major role played by emergency care in health care in the U.S. In recent years, the percentage of care delivered by emergency departments has grown significantly.

“I was stunned by the results. This really helps us better understand health care in this country. This research underscores the fact that emergency departments are critical to our nation’s healthcare delivery system.” said David Marcozzi, MD, MHS-CL, FACEP, an associate professor in the UMSOM Department of Emergency Medicine, and co-director of the UMSOM Program in Health Disparities and Population Health. “Patients seek care in emergency departments for many reasons. The data might suggest that emergency care provides the type of care that individuals actually want or need, 24 hours a day.”

Although he now focuses on population health, Dr. Marcozzi is an emergency medicine faculty physician himself, and works one or two days a week in the University of Maryland Medical Center emergency department, treating patients.

This is the first study to quantify the contribution of emergency department care to overall U.S. hospital-associated health care. The paper appears in the latest issue of International Journal for Health Services.

For this study, Dr. Marcozzi and his colleagues examined publicly available data from several national healthcare databases, which covered all 50 states and the District of Columbia. They studied the period between 1996 and 2010.

For 2010, the most recent year examined, the study found that there were nearly 130 million emergency department visits, compared with almost 101 million outpatient visits and nearly 39 million inpatient visits. Inpatient visits typically involve a hospital stay, but are planned ahead, as opposed to emergency department visits, which are generally at least somewhat unexpected.

Over the 14-year period of the study, more than 3.5 billion health care contacts associated with hospitals – emergency department visits, outpatient visits, and hospital admissions took place. Over that time, emergency care visits increased by nearly 44 percent. Outpatient visits accounted for nearly 38 percent of contacts. Inpatient care accounted for almost 15 percent of visits.

 

Certain groups were significantly more likely to use the emergency department as their method of healthcare. African-American patients were significantly more likely to have emergency department visits than patients in other racial groups; patients in the “other” insurance category, which includes those without any type of insurance, were significantly more likely to have emergency department visits than any other group. And patients living in the South were significantly more likely to have emergency department visits than patients living in other areas of the country.

African-American patients used emergency departments at a higher rate than other groups. In 2010, this group used the emergency department almost 54 percent of the time. The rate was even higher for urban African-American patients, who used emergency care 59 percent of the time that year. Emergency department use rates in south and west were 54 percent and 56 percent, respectively. In the northeast, use was much lower, 39 percent of all visits.

Certain groups accounted for increasing percentages of overall emergency room use: African-Americans, Medicare and Medicaid beneficiaries, residents of the south and west, and women. Dr. Marcozzi says that these findings point to increasing use by vulnerable populations, which is no surprise since socioeconomic and racial inequality creates barriers to the use health care.

The use of emergency care resources for non-emergency cases has been controversial, since initial emergency care patients often end up being seen for non-emergency medical issues. Some experts argue that emergency departments are covering for deficiencies in inpatient and outpatient resources, and for a lack of effective prevention strategies. This could contribute to the high rate of emergency department use. They argue that emergency room use should be reduced.

Dr. Marcozzi says this is unlikely to happen anytime soon, given the structure of the country’s health care system. He also notes that it may not be the best option. Instead, he says we should work to connect the care delivered in emergency departments with care delivered by the rest of the healthcare system.

The paper was co-authored by researchers at other academic institutions, including Brendan Carr, MD, MS, FACEP, a Professor of Emergency Medicine and an Associate Dean at Thomas Jefferson University.

“Emergency departments have long been a central piece in our healthcare system,” said UMSOM Dean E. Albert Reece, MD, PhD, MBA, who is also the Vice President for Medical Affairs, University of Maryland, and the John Z. and Akiko K. Bowers Distinguished Professor. “This research provides important data underscoring that reality. It also argues persuasively that the role of the emergency department must remain central. At the same time we must develop new strategies to improve the overall efficiency of our healthcare system, so that emergency departments are not overburdened.”

About the University of Maryland School of Medicine

Commemorating its 210th Anniversary, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 43 academic departments, centers, institutes, and programs; and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academies of Science, Engineering and Medicine, and a distinguished recipient of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic and clinically-based care for more than 1.2 million patients each year. The School has over 2,500 students, residents, and fellows, and nearly $450 million in extramural funding, with more than half of its academic departments ranked in the top 20 among all public medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has nearly 7,000 total employees. The combined School and Medical System (“University of Maryland Medicine”) has a total budget of $5 billion and an economic impact of nearly $15 billion on the state and local community. The School of Medicine faculty, which ranks as the 8th-highest public medical school in research productivity, is an innovator in translational medicine with 600 active patents and 24 start-up companies. The School works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu/

Learn More

• Department of Emergency Medicine

• Program in Health Disparities and Population Health

Contact

University of Maryland School of Medicine
David Kohn
Director of Medicine and Science Communications
University of Maryland School of Medicine
Office of Public Affairs
dkohn@som.umaryland.edu
(410) 706-7590

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