Journal of the American Geriatrics Society · 2025
Association Between Usual Clinician Presence and Emergency Department Revisitation.
СтатьяПоддержка исследования: вне правительства СШАПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Agboh Doreen S, Venkatesh Arjun K, Liang Yixuan, Salah Wafa, Rothenberg Craig, Ross Joseph S, Ganguli Ishani, Gettel Cameron J
Аннотация
BACKGROUND: Emergency department (ED) visit rates among older adults are increasing, often due to ambulatory care sensitive conditions (ACSCs) that may have been managed through access to a usual clinician-a provider who offers regular outpatient care. We sought to characterize ACSC-related ED visits and all-cause 30-day ED revisits among ED visits of older adults with and without a usual clinician.
METHODS: We conducted a pooled cross-sectional analysis of 2015-2020 Medicare Current Beneficiary Survey (MCBS) data linked to traditional Medicare claims of adults 65 and older. We compared ED visits that did and did not have a usual clinician with 3:1 propensity score matching on age, gender, race, chronic condition number (2+ vs. < 2), and geographical area. Our primary outcome was the proportion of ACSC-related Medicare beneficiary ED visits that were and were not associated with a usual clinician. Our secondary outcome was the presence of an all-cause ED revisit in the 30 days following the initial ED visit.
RESULTS: We examined 22,484 ED visits between 2015 and 2020, representing over 86 million ED visits nationally. Among ED visits by older adults, 20,849 (92.7%) were among those with a usual clinician. The proportion of ACSC-related ED visits by older adults with and without a usual clinician did not differ (14.8% vs. 14.7%, adjusted marginal difference [AMD] -0.20%, 95% CI: -2.17-1.78, p = 0.97). However, the proportion of all-cause 30-day ED revisits with a usual clinician among older adults was lower when compared with those without a usual clinician (25.6% vs. 35.9%, AMD 7.55%, 95% CI: 4.97-10.13, p < 0.001).
CONCLUSION: Emergency visits by older adults for ACSCs were similar regardless of the presence of a usual clinician; however, ED visits among older adults with a usual clinician were less likely to be followed by an ED revisit within 30 days.
METHODS: We conducted a pooled cross-sectional analysis of 2015-2020 Medicare Current Beneficiary Survey (MCBS) data linked to traditional Medicare claims of adults 65 and older. We compared ED visits that did and did not have a usual clinician with 3:1 propensity score matching on age, gender, race, chronic condition number (2+ vs. < 2), and geographical area. Our primary outcome was the proportion of ACSC-related Medicare beneficiary ED visits that were and were not associated with a usual clinician. Our secondary outcome was the presence of an all-cause ED revisit in the 30 days following the initial ED visit.
RESULTS: We examined 22,484 ED visits between 2015 and 2020, representing over 86 million ED visits nationally. Among ED visits by older adults, 20,849 (92.7%) were among those with a usual clinician. The proportion of ACSC-related ED visits by older adults with and without a usual clinician did not differ (14.8% vs. 14.7%, adjusted marginal difference [AMD] -0.20%, 95% CI: -2.17-1.78, p = 0.97). However, the proportion of all-cause 30-day ED revisits with a usual clinician among older adults was lower when compared with those without a usual clinician (25.6% vs. 35.9%, AMD 7.55%, 95% CI: 4.97-10.13, p < 0.001).
CONCLUSION: Emergency visits by older adults for ACSCs were similar regardless of the presence of a usual clinician; however, ED visits among older adults with a usual clinician were less likely to be followed by an ED revisit within 30 days.