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• W2755702016 abstract "Over the last two decades, new acute health care venues in the United States have emerged and grown. Urgent care centers, retail clinics and telemedicine have expanded as alternative convenient care options. Despite the rapid growth of these alternatives, the relative use of these venues and their impact on the volume of emergency department (ED) use is not well described. We aimed to describe trends in utilization of EDs, urgent care centers, retail clinics and telemedicine, with a focus on low-acuity conditions. Using claims data from a large national commercial health insurer from 2008-2015, we tracked utilization of different care venues. ED visits were identified by an ED-specific place of service code. Other care sites were identified using a combination of place of service codes, national provider identifiers and tax identification numbers. Our focus was on visits for a set of low-acuity conditions such as bronchitis, urinary tract infections, and rashes that are managed at all of these settings. These previously derived conditions each comprise 2% or more of all visits to retail clinics and urgent care centers, and excluded diagnostic codes that would require treatment in an ED. Patient burden of illness was captured using the diagnostic-cost-group (DxCG) risk score. From 2008 to 2015, an average of 21 million insured members per study year made 52 million visits to acute care venues, with 23 million visits for low-acuity conditions. The number of visits for low-acuity conditions increased from 127 to 154 visits/1,000 members. There were substantial increases in the utilization of urgent care (93% increase, 41 to 79 visits/1,000), retail clinics (183% increase, 6 to 17 visits/1,000) and telemedicine (0 to 4 visits/1,000) (Figure 1). In contrast, there was a 31% decrease in visits to EDs for these conditions (80 to 55 visits/1,000). From 2008 to 2015 the fraction of low-acuity visits that occurred in the ED decreased from 63% to 35%. The pediatric population accounted for most of the decline in low-acuity ED visits (0-17 years: 44 to 22 visits/1,000 vs. 18-64 years: 29 to 27 visits/1,000). In contrast, the growth in urgent care utilization was more evenly distributed (0-17 years: 13 to 22 visits/1,000, 18-44 years: 18 to 35 visits/1,000, 45-64 years: 8 to 18 visits/1,000). Patients visiting non-ED settings for low-acuity conditions were healthier (mean risk score: ED 3.31, urgent care 1.25, retail clinic 0.94, telemedicine 0.94), and a greater proportion were female (ED 54%, urgent care 58%, retail clinic 64%, telemedicine 68%). Over the eight-year period from 2008-2015, there were dramatic shifts in where patients in a national commercial insurance plan received care for low-acuity conditions. While use of retail clinics and telemedicine is rising, these settings represent a low proportion of visits. There has been an almost doubling of urgent care use with a corresponding drop in ED utilization. EDs now provide a minority of on-demand care visits for low-acuity conditions." @default.
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• W2755702016 date "2017-10-01" @default.
• W2755702016 modified "2023-09-25" @default.
• W2755702016 title "172 Trends in Site of Care for Low-Acuity Conditions Among Those With Commercial Insurance, 2008-2015" @default.
• W2755702016 doi "https://doi.org/10.1016/j.annemergmed.2017.07.199" @default.
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