Abstract
Objectives
Ambulatory‐care‐sensitive conditions (ACSCs) represent emergency department (ED) visits and hospital admissions that might have been avoided through earlier primary care intervention. We characterize the current frequency and cost of ACSCs among older adults (≥65 years of age) in the ED.
Methods
This study is a retrospective analysis of Centers for Medicare and Medicaid Services (CMS) national claims data distributed by the Research Data Assistance Center, a CMS contractor based at the University of Minnesota. We analyzed outpatient ED‐based national claims data for visits made by traditional fee‐for‐service (FFS) Medicare beneficiaries in 2016. ACSCs were identified according to the Agency for Healthcare Research and Quality's Prevention Quality Indicators criteria, which require that the ACSC be the primary diagnosis for the visit. Analysis was done in Alteryx and R.
Results
We documented nearly 1.8 million ACSC ED visits in 2016, finding that ≈10.6% of all ED visits by older adult FFS Medicare beneficiaries were associated with an ACSC. ACSC ED visits resulted in admission more often (39.7%) than non‐ACSC ED visits (23.9%). Notably, 83% of patients with short‐term complications from diabetes were admitted.
Conclusions
ED visits for a primary diagnosis of an ACSC highlight opportunities to improve access to preventive care, particularly earlier recognition and treatment of patients’ deteriorating conditions that could have potentially precluded the need for the ED visit. An opportunity exists to leverage ED‐based initiatives during an ACSC ED visit to support appropriate community and care transitions of these high‐risk patients.
Background
Ambulatory‐care sensitive conditions (ACSCs) represent emergency department visits and hospital admissions that might have been avoided through earlier primary care intervention. Previous research has found that over 15% of ED visits made by older adults are for ACSCs, nearly double the overall rate across all ages. 1 Notably, ACSC‐related ED visits exhibit a much higher rate of hospital admission (34.4% compared to 14.0% for non‐ACSC ED visits among adults aged 18 and over). 1 Potentially avoidable ED visits are of concern as ED visits (and subsequent hospital admissions) have been associated with poor health outcomes, such as loss of mobility, function, and independence. 2 Furthermore, unnecessary utilization of these health care services is indicative of inadequate preventive care and inefficient use of high‐cost resources. 3 Compared to an outpatient ACSC visit, payments for an ACSC ED visit have been reported to be 2.5 times higher, and payments for an ACSC admission are 12.7 times higher than an outpatient ACSC visit. 4
Although the scope of potentially avoidable ED visits among older adults and subsequent hospital admissions have been previously reported among individual institutions and specific geographic regions, reports focusing on the burden of potentially preventable ED visits and hospital admissions at a national level are few, rely on outdated data 5 and do not follow the current version of standardized methodology developed by the Agency for Healthcare Research and Quality (AHRQ). To understand the current burden, we identified and analyzed national claims data for ED visits by older adults determined to be for potentially preventable conditions using the criteria defined by AHRQ's Prevention Quality Indicators (PQIs). 6 Analyses of potentially preventable conditions in health services research using previous versions of these criteria have been well documented. 7