The information contained in the Centers for Disease Control and Prevention's (Atlanta) "Ambulatory Medical Care Utilization Estimates for 2005" and "National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary," prepared and recently released by the CDC's National Center for Health Statistics (Hyattsville, Maryland), offers no surprise conclusions. But it does add to the concerns expressed previously by a variety of reports on issues such as emergency room overcrowding and the rise in the number of people who have nowhere else to go for their healthcare other than the local emergency room.
Those concerns also include such issues as psychiatric patients going first to emergency departments (EDs) for treatment — probably due to the fact that many such hospital psych units have closed — the fact that most visits were made by the very young, and infants under 12 months; and the number of homeless individuals who turn to EDs for care.
These statistics come at a time when — from 1995 to 2005 — the number of hospital EDs decreased from 4,176 to 3,795, which increased the annual number of visits per ED from 23,119 in 1995 to 30,388 in 2005.
An estimated total 115.3 million visits were made to hospital EDs in 2005, or about 39.6 visits per 100 persons.
"What that means is that for the [EDs] that are left open, they are seeing more and more patients," Catharine Burt, chief of the ambulatory care statistics branch at the the National Center for Health Statistics and lead author of the study, told Medical Device Daily. "So that's what has contributed to the crowding … long waiting times … and patients leaving before they are treated by physicians."
The hospital ambulatory/ED survey data are incorporated into the "Ambulatory Medical Care Utilization Estimates for 2005."
Burt also said there has been renewed interest in the data collected in these reports due to attention being focused on the U.S. healthcare system by Michael Moore's film, "Sicko," which focuses on what Moore attempts to underline as deficiencies in U.S. healthcare delivery.
She said that, all in all, there is "nothing new" about many of the findings.
Many hospitals, she said, have closed because they could not continue to operate and continue to care for non-paying patients. By law, EDs are required to stabilize any patient who walks in the door, regardless of their ability to pay, but hospitals do not receive subsidies even as result of this requirement.
(As a case in point, Grady Memorial Hospital [Atlanta], a major downtown hospital that treats the city's indigent currently experiences ongoing million-dollar deficits and is threatening closure.)
Burt said that the emergency room "is a barometer for health in America," but that it is "very hard to second guess" why people go to the ED because the surveys do not contain "all the denominators." However, she said the answer typically comes down to "accessibility and cost."
For example, in the utilization report, the "Ambulatory Medical Care Utilization Estimates for 2005" — which contains information on patient visits not only to EDs, but also to outpatient centers and physician offices — the survey found the ED rate for patients with no insurance was about twice that of those with private insurance.
Also, according to the CDC, patient visits to physician offices were higher for individuals with private health insurance compared to uninsured persons.
Three age groups have shown an "increasing trend" in the number of visits to EDs since 1995: those aged 22-49 (up by 11%), 50 to 64 (up by 13%) and 65 years and older (up by 11%), the report found.
Infants under 12 months of age accounted for 91.3 visits per 100 infants, representing about 3.8 million visits to EDs.
The utilization rate for EDs was higher for non-Hispanic black persons than for non-Hispanic whites. The ED utilization rate for Asian and American Indian or Alaska Native individuals was less than for whites.
Also, in 2005, about 500,000 visits, or 0.4% of visits were made by homeless individuals, or 62.7 visits per 100 homeless people.
Also, almost three-quarters, or 72.2% of ED visits were made to voluntary non-profit hospitals.
The report also says that EDs located in metropolitan areas were the recipients of 85.5% of annual ED "encounters." About 36.9% of ED visits were made to hospitals that are also designated as trauma centers, the report says.
Private insurance was "the most frequent expected source of payment," the report finds, accounting for 39.9% of all ED visits. Other sources included Medicaid or State Children's Health Insurance Program (24.9%) and Medicare (16.6%).
For example, the visit rate for Medicaid patients was 88 per 100 persons with Medicaid coverage, which was higher than the rate for those with Medicare, or 51 per 100 persons.
In 16.7% of the visits, no insurance was reported.
Where the report focuses specifically on EDs, it finds that the most frequently diagnosed major disease categories were injuries and poisonings; symptoms, signs and "ill-defined" conditions (19.3%); and diseases of the respiratory system (11%).
The "most frequently reported specific" reasons that patients gave for visiting the hospital were abdominal pain (6.8%); chest pain (5%) and fever (4.4%).
The report notes that chronic conditions are at the root of many primary ED diagnoses. But while diagnoses such as chronic obstructive pulmonary disease (COPD), ischemic heart disease, asthma, congestive heart failure, cerebrovascular disease and cancer have all decreased in EDs in statistically significant numbers, others have increased.
For example, both hypertension and depression as a percentage of visits have increased "significantly" over 1995, the report says.
In Burt's report on ambulatory care statistics for 2005, she said it was found that across the board in outpatient settings, antidepressants were the "No. 1 prescription" prescribed by doctors, something that was a new finding in this most recent report.
Again, she said, the reason as to why antidepressants have become the number one drug is unclear. Of all the visits to all ambulatory centers, there were 2.4 billion medications prescribed or administered at those visits.
In the hospital ED study, it notes that 1.8 million visits were attributed to the adverse effects of medical treatment, including complications of medical and surgical procedures, or 2.6% of injury visits, and adverse effects of medication, or 1.8% of injury visits.
Burt said that even though more medications are being prescribed, the number of adverse reactions to medication reported in EDs has "sort of leveled off, but what has really jumped" are the number of visits to EDs due to complications from surgical procedures, whether that be a surgical site infection or complications related to the insertion of shunts and stents, which she said do account for some of those visits.
According to the report, The National Hospital Ambulatory Medicare Care Survey (NHAMCS) was initiated in 1992 to "gather, analyze and disseminate information about the health care provided by hospital EDs and OPDs."
NHAMCS is part of the "ambulatory component" of the National Health Care Survey, which the CDC describes as a "family of surveys that measures healthcare utilization across various types of providers."