Emergency Department Visits for Nonurgent Conditions: Systematic Literature Review
1200 S Hayes St, Arlington, VA 22202. E-mail: .The American journal of managed care (Impact Factor: 2.26). 02/2013; 19(1):47-59.
Background: A large proportion of all emergency department (ED) visits in the United States are for nonurgent conditions. Use of the ED for nonurgent conditions may lead to excessive healthcare spending, unnecessary testing and treatment, and weaker patient-primary care provider relationships. Objectives: To understand the factors influencing an individual's decision to visit an ED for a nonurgent condition. Methods: We conducted a systematic literature review of the US literature. Multiple databases were searched for US studies published after 1990 that assessed factors associated with nonurgent ED use. Based on those results we developed a conceptual framework. Results: A total of 26 articles met inclusion criteria. No 2 articles used the same exact definition of nonurgent visits. Across the relevant articles, the average fraction of all ED visits that were judged to be nonurgent (whether prospectively at triage or retrospectively following ED evaluation) was 37% (range 8%-62%). Articles were heterogeneous with respect to study design, population, comparison group, and nonurgent definition. The limited evidence suggests that younger age, convenience of the ED compared with alternatives, referral to the ED by a physician, and negative perceptions about alternatives such as primary care providers all play a role in driving nonurgent ED use. Conclusions: Our structured overview of the literature and conceptual framework can help to inform future research and the development of evidence-based interventions to reduce nonurgent ED use.
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- "7 Reasons given by parents for their decisions to go to pediatric EDs (PEDs), even without referral by their children's primary care physicians, include that they seek a quick and convenient solution to a health issue [1, 8, 10, 15–18]; that they view the PED as the best place to go because of its better physicians and/or medical equipment       ; that they are dissatisfied with their primary care physician's office or the physician's diagnosis and/or treatment   ; that they are very worried about their child's health    ; that they are in financial straits  ; that they have a habit of going to the ED   ; and that they have no access to other care   . Adult patients have given similar reasons  . "
ABSTRACT: Parents frequently bring their children to general or pediatric emergency departments (EDs), even though many of these visits are judged by others to be “nonurgent” and inappropriate. This study examined the motives behind parents’ decisions to take their children to a pediatric emergency department (PED). At a PED in Toulouse, France, 497 parents rated their level of agreement with each of 69 possible motives—representing all categories of human motivation—for coming to the PED that day. Exploratory and confirmatory factor analyses found evidence for six separable motives, called (in order of importance) (a) Seeking Quick Diagnosis, Treatment, and Reassurance; (b) PED as the Best Place to Go; (c) Empathic Concern for Child’s Suffering; (d) Being Considered by Others as Responsible Parents; (e) External Factors; and (f) Dissatisfaction with Previous Consultation. Conclusions . Parents’ motives in bringing their children to the PED are primarily serious and goal-oriented. They are also often emotion based, as would be expected in parents of ill children. The parents would be unlikely to agree that these visits were inappropriate.10/2015; XX(XX):XX. DOI:10.1155/2015/978412
- The American journal of managed care 02/2013; 19(1):33-5. · 2.26 Impact Factor
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ABSTRACT: Background: In the face of escalating spending, measuring and maximizing the value of health services has become an important focus of health reform. Recent initiatives aim to incentivize high-value care through provider and hospital payment reform, but the role of the emergency department (ED) remains poorly defined. Objectives: To achieve an improved understanding of the value of emergency care, we have developed a framework that incorporates the perspectives of stakeholders in the delivery of health services. Methods: A pragmatic review of the literature informed the design of this framework to standardize the definition of value in emergency care and discuss outcomes and costs from different stakeholder perspectives. The viewpoint of patient, provider, payer, health system, and society is each used to assess value for emergency medical conditions. Results: We found that the value attributed to emergency care differs substantially by stakeholder perspective. Potential targets to improve ED value may be aimed at improving outcomes or controlling costs, depending on the acuity of the clinical condition. Conclusion: The value of emergency care varies by perspective, and a better understanding is achieved when specific outcomes and costs can be identified, quantified, and measured. Using this framework can help stakeholders find common ground to prioritize which costs and outcomes to target for research, quality improvement efforts, and future health policy impacting emergency care. (C) 2014 Elsevier Inc.Journal of Emergency Medicine 05/2014; 47(3). DOI:10.1016/j.jemermed.2014.04.017 · 0.97 Impact Factor
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