EMS PRO FEATURE
Uninsured Trauma Patients Are More Likely to Use the ED for Follow-Up Care
Adil H. Haider, M.D., M.P.H.
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.
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 emer- gency 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.
“Just providing patients access to doctors outside of the ER clearly isn’t working, especially for those without insur- ance,” said study leader Adil H. Haider, M.D., M.P.H., an assistant pro- fessor of surgery at the Johns Hopkins Univer- sity School of Medicine. “We need better ways to help patients discharged from the hospital receive appropriate follow-up care,” Haider added.
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Haider and his col- leagues 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.
Along with being un- insured or government insured and living in low-income neighbor- hoods, black patients and those with more seri- ous injuries were more likely to return to the ED for follow-up care.
“Clearly, there are more factors at play than just having an appointment or access to care,” said Haider, who is also co- director of Johns Hop- kins’ Center for Surgery Trials and Outcomes Research.
“It may be that going to the ER, typically con- sidered the provider of last resort, is the easiest option,” Haider said.
“Regardless of the un- derlying cause, further research is needed to investigate how the sys- tem can be more efficient in taking care of these vulnerable populations,” Haider added. “Improv- ing follow-up care for these vulnerable patients will not only improve the quality of their care, but will also ease the bur- den on already strained emergency departments and reduce overall healthcare costs,” Haider commented. u
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