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Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments.
West J Emerg Med. 2019 Aug 06; 20(5):710-716.WJ

Abstract

INTRODUCTION

The emergency department (ED) has long served as a safety net for the uninsured and those with limited access to routine healthcare. This study aimed to compare the characteristics and severity of ED visits in an Illinois academic medical center (AMC) and community hospital (CH) of a single health system before and after the implementation of the Affordable Care Act (ACA).

METHODS

This was a retrospective record review of 357,764 ED visits from January 1, 2011-December 31, 2016, of which 74% were at the AMC and 26% at the CH. We assessed the severity of ED visits by applying the previously validated Ballard algorithm, which classifies ED visits as non-emergent, intermediate, or emergent. Descriptive analyses were conducted to compare the characteristics of ED visits before and after the implementation of the ACA. We conducted multilevel logistic regression analysis to examine the odds of non-emergent compared to intermediate/emergent ED visits by the ACA implementation status controlling for patient demographic characteristics, insurance status, and multiple visits per patient.

RESULTS

ED visits for patients with Medicaid or other governmental coverages increased in the post-ACA compared to pre-ACA period (Pre: 33.2 % vs Post: 38.3% at the AMC, and Pre: 29.7% vs Post: 35.1% at the CH). A statistically significant decrease in ED visits for uninsured patients was observed at the AMC and CH in the post-ACA period compared to the pre-ACA period (Pre: 12.1% vs Post: 6.4%, and Pre: 13.9% vs Post: 9.8%, respectively). Results from the regression analysis showed a significant decreased odds of non-emergent vs intermediate/emergent ED visits during the post-ACA period compared to the pre-ACA period at the AMC (odds ratio [OR] 0.68; confidence interval [CI], 0.66-0.70). However, an increased odds of non-emergent vs. intermediate/emergent ED visits was observed at the CH (OR 1.09; CI, 1.04-1.14).

CONCLUSION

Similar to other Medicaid expansion states, ED utilization for uninsured patients decreased at both the AMC and the CH in the post-ACA period. While Medicaid visits for children < 18 years declined in the post-ACA period, it increased for ages 21 to 65 years of age. Contrary to our hypothesis, the severity of emergent ED visits increased in the post-ACA period but not at the CH.

Authors+Show Affiliations

Loyola University Chicago, Stritch School of Medicine, Department of Emergency Medicine, Maywood, Illinois.Loyola University Chicago, Stritch School of Medicine, Department of Emergency Medicine, Maywood, Illinois.University of Illinois at Chicago, Advocate Christ Medical Center, Department of Emergency Medicine, Oak Lawn, Illinois.Public Health Sciences at Loyola University Chicago, Maywood, Illinois.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

31539326

Citation

Probst, Beatrice D., et al. "Examining the Effect of the Affordable Care Act On Two Illinois Emergency Departments." The Western Journal of Emergency Medicine, vol. 20, no. 5, 2019, pp. 710-716.
Probst BD, Walls L, Cirone M, et al. Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments. West J Emerg Med. 2019;20(5):710-716.
Probst, B. D., Walls, L., Cirone, M., & Markossian, T. (2019). Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments. The Western Journal of Emergency Medicine, 20(5), 710-716. https://doi.org/10.5811/westjem.2019.6.41943
Probst BD, et al. Examining the Effect of the Affordable Care Act On Two Illinois Emergency Departments. West J Emerg Med. 2019 Aug 6;20(5):710-716. PubMed PMID: 31539326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments. AU - Probst,Beatrice D, AU - Walls,Luther, AU - Cirone,Michael, AU - Markossian,Talar, Y1 - 2019/08/06/ PY - 2018/12/10/received PY - 2019/06/08/accepted PY - 2019/9/21/entrez PY - 2019/9/21/pubmed PY - 2019/12/31/medline SP - 710 EP - 716 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 20 IS - 5 N2 - INTRODUCTION: The emergency department (ED) has long served as a safety net for the uninsured and those with limited access to routine healthcare. This study aimed to compare the characteristics and severity of ED visits in an Illinois academic medical center (AMC) and community hospital (CH) of a single health system before and after the implementation of the Affordable Care Act (ACA). METHODS: This was a retrospective record review of 357,764 ED visits from January 1, 2011-December 31, 2016, of which 74% were at the AMC and 26% at the CH. We assessed the severity of ED visits by applying the previously validated Ballard algorithm, which classifies ED visits as non-emergent, intermediate, or emergent. Descriptive analyses were conducted to compare the characteristics of ED visits before and after the implementation of the ACA. We conducted multilevel logistic regression analysis to examine the odds of non-emergent compared to intermediate/emergent ED visits by the ACA implementation status controlling for patient demographic characteristics, insurance status, and multiple visits per patient. RESULTS: ED visits for patients with Medicaid or other governmental coverages increased in the post-ACA compared to pre-ACA period (Pre: 33.2 % vs Post: 38.3% at the AMC, and Pre: 29.7% vs Post: 35.1% at the CH). A statistically significant decrease in ED visits for uninsured patients was observed at the AMC and CH in the post-ACA period compared to the pre-ACA period (Pre: 12.1% vs Post: 6.4%, and Pre: 13.9% vs Post: 9.8%, respectively). Results from the regression analysis showed a significant decreased odds of non-emergent vs intermediate/emergent ED visits during the post-ACA period compared to the pre-ACA period at the AMC (odds ratio [OR] 0.68; confidence interval [CI], 0.66-0.70). However, an increased odds of non-emergent vs. intermediate/emergent ED visits was observed at the CH (OR 1.09; CI, 1.04-1.14). CONCLUSION: Similar to other Medicaid expansion states, ED utilization for uninsured patients decreased at both the AMC and the CH in the post-ACA period. While Medicaid visits for children < 18 years declined in the post-ACA period, it increased for ages 21 to 65 years of age. Contrary to our hypothesis, the severity of emergent ED visits increased in the post-ACA period but not at the CH. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/31539326/Examining_the_Effect_of_the_Affordable_Care_Act_on_Two_Illinois_Emergency_Departments_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31539326/ DB - PRIME DP - Unbound Medicine ER -