Emergency Department Utilization (EDU)

Assesses emergency department (ED) utilization among commercial (18 and older) and Medicare (18 and older) health plan members through an observed-to-expected ratio. Plans report observed rates of ED use and a predicted rate of ED use based on the health of the member population and other factors.

Why It Matters

ED visits are a high-intensity service and a cost burden on the health care system, as well as on patients. Some ED events may be attributed to preventable or treatable conditions. A high rate of ED utilization may indicate poor care management, inadequate access to care or poor patient choices, resulting in ED visits that could be prevented.1,2 Plans can ensure that members receive appropriate, coordinated primary care to address preventable ED visits.

Results

EMERGENCY DEPARTMENT UTILIZATION RATE (18—85+ YEARS)*
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016 202.3 193.6

EMERGENCY DEPARTMENT UTILIZATION RATE (65-74 YEARS)*
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016 _ _ _ 427.1 351.0

EMERGENCY DEPARTMENT UTILIZATION RATE (75-84 YEARS)*
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016 _ _ _ 467.8 445.0

EMERGENCY DEPARTMENT UTILIZATION RATE (85+ YEARS)*
Commercial Medicaid Medicare
Year HMO PPO HMO HMO PPO
2016 -- -- -- 556.2 597.8

*Lower rates signify better performance.

References

  1. Dowd, B., M. Karmarker, T. Swenson, et al. 2014. “Emergency department utilization as a measure of physician performance.” American Journal of Medical Quality 29 (2), 135–43. http://ajm.sagepub.com/content/29/2/135.long
  2. Agency for Healthcare Research and Quality. 2015. Measures of Care Coordination: Preventable Emergency Department Visits. Accessed at http://www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/ carecoordination/carecoord-measures2.html

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