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Am J Med Qual. 2015 Mar-Apr;30(2):156-60. doi: 10.1177/1062860614525225. Epub 2014 Feb 28.

Patient-reported reasons for emergency department visits in the urban Medicaid population.

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Johns Hopkins Medical Institutions, Baltimore, MD
UnitedHealthcare Community Plan of Maryland, Elkridge, MD.
Johns Hopkins Medical Institutions, Baltimore, MD.


This study investigated patient-reported reasons for treat-and-release emergency department (ED) visits by Medicaid beneficiaries. An in-house-designed educational survey was conducted that consisted of 3 components: patient's health, patient's primary care, and patient's ED visit. An ED patient was asked an open-ended question about the reason for a recent ED visit. The patient's answer was classified into 1 of 3 types: health care service delivery issues, population behavior issues, and unavoidable ED visits. Among 2711 ED visits, 56% were related to health care service delivery issues (ie, access to care, primary care provider [PCP] availability), 2% were associated with population behavior issues, and 42% were unavoidable. For those ED visits related to PCP unavailability, 72% occurred during off-hours or weekends and 28% were because of no timely PCP appointments. The findings suggest that inadequate access to primary care is a major cause of potentially avoidable ED utilization in the Medicaid population.


Medicaid; access to care; emergency department; emergency room; primary care

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