Emergency Department Utilization (EDU)

For people 18 years of age and older, the risk-adjusted ratio of observed-to-expected emergency department (ED) visits during the measurement period.

Why It Matters

ED visits are a high-intensity service and a cost burden on the health care system, as well as on patients. A 2020 study found aggregate costs for nationwide ED visits of $76.3 billion ⁽¹⁾. A significant number of ED events can even be treated in urgent or primary care settings. A 2024 study found that among adults ages 18 to 64 who utilized the ED, 24% did so for non-urgent reasons ⁽²⁾. A high rate of ED utilization may indicate poor care management, inadequate access to care or lack of patient education surrounding care alternatives, resulting in ED visits that could have been prevented ^(3,4). Plans can ensure that members receive appropriate, coordinated primary care to address preventable ED visits.

Each year, approximately 1 out of every 5 U.S. adults utilize the ED for health care ⁽⁵⁾. Common reasons for patients visiting the ED rather than urgent care or primary care facilities include perceived severity of the medical problem, inconvenient doctor’s office hours and lack of access to primary care providers. Up to 60% of all ED visits remain non-urgent and potentially unnecessary ^(6,7). Unnecessary ED use causes overcrowding, increased wait times, and a resulting inability of hospital staff to provide efficient, quality care to patients with truly emergent conditions. Additionally, unnecessary use strains limited hospital and community resources, as ED visits are costlier to hospitals and patients than comparable office visits. Several studies have suggested that these non-urgent ED visits can be prevented by optimal care in outpatient settings.

Health plans can reduce ED utilization by ensuring appropriate disease management and care coordination are provided in primary care settings ⁽⁸⁾. Plans can also provide an alternative to the ED by increasing member access to primary care and urgent care settings.

Historical Results – National Averages

Performance results for this measure are currently unavailable. Visit our Quality Compass page to explore data licensing options and gain access to detailed performance results for this measure.