Primary Care

Majority of conditions treated in emergency departments are treatable in primary care clinics

If patients treated at an emergency department (ED) for a condition treatable or preventable through care from an ambulatory care clinic (ambulatory-care-sensitive conditions, ACSCs) were seen at a clinic instead, cost savings could reach 66 to 84 percent, according to a new study. The researchers examined 2007 data from three primary care safety-net clinics and four EDs that were part of the Carolinas HealthCare System. They found that 59 percent of 191,622 outpatient ED visits in the Charlotte, NC area were for ACSCs, 11.2 percent were for necessary emergency care, and 20.8 percent were related to injury.

Groups most likely to go to an ED for an ACSC were blacks and Hispanics, persons without health insurance or those insured by Medicare or Medicaid, females, children 2 years or younger, and children ages 3-18 years. Total hospital charges (not including physician charges) for ACSC-related visits to the ED were $124,967,120 (average per-visit charge of $1,099), with ED costs 320 to 728 percent higher than for care at a primary care clinic. The researchers suggest that solutions to this complex problem will require payers and hospital systems to design and invest in novel targeted interventions. Their study was funded in part by the Agency for Healthcare Research and Quality (HS16023).

More details are in "Cost analysis of the use of emergency departments for primary care services in Charlotte, North Carolina" by Andrew McWilliams, M.D., M.P.H., Hazel Tapp, Ph.D., Jolene Barker, M.S., and others in the July/August 2011 North Carolina Medical Journal 72(4), pp. 265-271.

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