Featured Research

from universities, journals, and other organizations

Uninsured trauma patients are more likely to use the emergency department for follow-up care

Date:
August 25, 2011
Source:
Johns Hopkins Medical Institutions
Summary:
Providing access to an outpatient clinic isn't enough to keep some trauma patients who have been discharged from the hospital from returning to the emergency department for follow-up care, even for such minor needs as pain medication refills and dressing changes, according to new research.

Providing access to an outpatient clinic isn't enough to keep some trauma patients who have been discharged from the hospital from returning to the emergency department (ED) for follow-up care, even for such minor needs as pain medication refills and dressing changes, according to new Johns Hopkins research.

Reporting in the Annals of Emergency Medicine, the researchers say that patients with Medicaid, Medicare and those with no insurance were 60 percent more likely to seek such care in the ED. Those living in poor neighborhoods were 70 percent more likely than patients with insurance to head to the ED instead of going to a doctor's office or clinic.

The findings suggest that, for reasons that are not well understood, many patients who could receive less expensive outpatient care won't or can't seek it, the Hopkins team says. These patients, the researchers say, end up receiving far more costly care in the ED, where they have longer waits and add to the notorious crowding that burdens many emergency rooms.

"Just providing patients access to doctors outside of the ER clearly isn't working, especially for those without insurance," says study leader Adil H. Haider, M.D., M.P.H., an assistant professor of surgery at the Johns Hopkins University School of Medicine. "We need better ways to help patients discharged from the hospital receive appropriate follow-up care."

Haider and his colleagues analyzed the records of 6,675 trauma patients admitted to The Johns Hopkins Hospital between 1997 and 2007. Roughly 13 percent of these patients returned to the ED within a month of discharge, yet nearly 90 percent of them were not readmitted into the hospital, suggesting that their ER visit was avoidable and that they could have been treated in an outpatient clinic, Haider says. Among the small number of return patients who were readmitted, the main cause was complications from their original injury and hospitalization.

Along with being uninsured or government insured and living in low-income neighborhoods, black patients and those with more serious injuries were more likely to return to the ED for follow-up care. Patients who were discharged to a rehabilitation, nursing or acute-care facility were significantly less likely to return to the ER than those who were discharged home. The nature of the injury made no difference, the researchers found. Those with penetrating injury, like stabbing or gunshot wounds, were no more and no less likely to seek repeat care in the ER than those with blunt trauma injuries, like those sustained in car crashes.

All trauma patients discharged from Johns Hopkins receive a free follow-up appointment, regardless of insurance. Therefore, access to care shouldn't be an issue even for those who have no insurance and are too poor to afford private care, the investigators say.

"Clearly, there are more factors at play than just having an appointment or access to care," says Haider, who is also co-director of Johns Hopkins' Center for Surgery Trials and Outcomes Research.

To mitigate this problem, the Hopkins staff now makes the initial follow-up appointment for the patient before discharge. Yet, even so, the researchers say, some of the poorest patients may find it hard to believe there is no up-front cost, and they may know they won't have to pay before being seen at the ED. Another possible factor, the researchers add, might be that clinic appointment times are inconvenient for those who cannot take time off work or who have no transportation.

"It may be that going to the ER, typically considered the provider of last resort, is the easiest option," Haider says.

"Regardless of the underlying cause, further research is needed to investigate how the system can be more efficient in taking care of these vulnerable populations," Haider adds. "Improving follow-up care for these vulnerable patients will not only improve the quality of their care, but will also ease the burden on already strained emergency departments and reduce overall healthcare costs."

Other Johns Hopkins researchers who participated in the study include Karim S. Ladha, M.D.; J. Hunter Young, M.D., M.H.S.; Derek K. Ng, Sc.M.; and David T. Efron, M.D., M.P.H.


Story Source:

The above story is based on materials provided by Johns Hopkins Medical Institutions. Note: Materials may be edited for content and length.


Cite This Page:

Johns Hopkins Medical Institutions. "Uninsured trauma patients are more likely to use the emergency department for follow-up care." ScienceDaily. ScienceDaily, 25 August 2011. <www.sciencedaily.com/releases/2011/08/110825152501.htm>.
Johns Hopkins Medical Institutions. (2011, August 25). Uninsured trauma patients are more likely to use the emergency department for follow-up care. ScienceDaily. Retrieved July 23, 2014 from www.sciencedaily.com/releases/2011/08/110825152501.htm
Johns Hopkins Medical Institutions. "Uninsured trauma patients are more likely to use the emergency department for follow-up care." ScienceDaily. www.sciencedaily.com/releases/2011/08/110825152501.htm (accessed July 23, 2014).

Share This




More Health & Medicine News

Wednesday, July 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Idaho Boy Helps Brother With Disabilities Complete Triathlon

Idaho Boy Helps Brother With Disabilities Complete Triathlon

Newsy (July 23, 2014) An 8-year-old boy helped his younger brother, who has a rare genetic condition that's confined him to a wheelchair, finish a triathlon. Video provided by Newsy
Powered by NewsLook.com
Stone Fruit Listeria Scare Causes Sweeping Recall

Stone Fruit Listeria Scare Causes Sweeping Recall

Newsy (July 22, 2014) The Wawona Packing Company has issued a voluntary recall on the stone fruit it distributes due to a possible Listeria outbreak. Video provided by Newsy
Powered by NewsLook.com
Huge Schizophrenia Study Finds Dozens Of New Genetic Causes

Huge Schizophrenia Study Finds Dozens Of New Genetic Causes

Newsy (July 22, 2014) The 83 new genetic markers could open dozens of new avenues for schizophrenia treatment research. Video provided by Newsy
Powered by NewsLook.com
CDC Head Concerned About a Post-Antibiotic Era

CDC Head Concerned About a Post-Antibiotic Era

AP (July 22, 2014) Sounding alarms about the growing threat of antibiotic resistance, CDC Director Tom Frieden warned Tuesday if the global community does not confront the problem soon, the world will be living in a devastating post-antibiotic era. (July 22) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins