Admission Rates from Emergency Departments Vary Widely

A new study in the January 6 issue of Medical Care and Research Review found a greater than 2.5-fold variation in the admission rate from the emergency department in a sample of hospitals across 28 States. This indicates wide variation in a costly, everyday decision that will require further study, in light of the major impact that hospital admissions play in rising health care costs, according to the study authors from AHRQ and George Washington University. For-profit hospitals, trauma centers, and hospitals with higher proportions of Medicare and uninsured patients had higher admission rates. Also, local practice patterns and availability of primary care doctors were important factors. Fewer primary care doctors were associated with higher admission rates, while some admissions decisions were influenced by local care standards. Select to access the abstract on PubMed.®

2013 Jan 6. [Epub ahead of print]

Variation in Emergency Department Admission Rates Across the United States.

Pines JM, Mutter RL, Zocchi MS.

Abstract

There were more than 19 million hospitalizations in 2008 from hospital-based emergency departments (EDs), representing nearly 50% of all U.S. admissions. Factors related to variation in hospital-level ED admission rates are unknown. Generalized linear models were used to assess patient-, hospital-, and community-level factors associated with ED admission rates across a sample of U.S. hospitals using Healthcare Cost and Utilization Project data. In 1,376 EDs, the mean ED admission rate, when defined as direct admissions and also transfers from one ED to another hospital, was 17.5% and varied from 9.8% to 25.8% at the 10th and 90th percentiles. Higher proportions of Medicare and uninsured patients, more inpatient beds, lower ED volumes, for-profit ownership, trauma center status, and higher hospital occupancy rates were associated with higher ED admission rates. Also, hospitals in counties with fewer primary care physicians per capita and higher county-level ED admission rates had higher ED admission rates.