data presentation final web may2010pain in limb 1,421 viral infection nos 1,383 backache nos 1,344...

R5 Initiative— Improving Access to the Right Care in the Right Place at the Right Time

for the Right Reason at the Right Cost

Presentation of Quantitative Data Findings to R5 WorkgroupsKevin Jobin-Davis, PhDApril/May 2010

Healthy Capital District Initiative | www.hcdiny.org2


NYU Emergency Department Classification

Non-Emergent – The patient’s initial complaint, presenting symptoms, vital signs, medical history, and age indicated that immediate medical care was not required within 12 hours.


Top 10 Non-Emergent Diagnoses

ICD9 Diagnosis Total

Dental Disorder NOS 2,677Headache 2,172Lumbago 2,146Oth CCE Comp Preg-AP 1,810Acute Pharyngitis 1,767Urinary Tract INF NOS 1,479Pain in Limb 1,421Viral Infection NOS 1,383Backache NOS 1,344Migraine NOS W/O Sm 1,293Grand Total 17,493

Top 10 Non-Emergent Diagnoses



Emergent/Primary Care Treatable – Based on information in the record, treatment was required within 12 hours, but care could have been provided effectively and safely in a primary care setting. The complaint did not require continuous observation, and no procedures were performed or resources used that are not available in a primary care setting (e.g., CAT scan or certain lab tests).



ABD/Pelv Swell-Site NOS Cellulitis/Abscess Mouth Infect/Parasite Dis NOS Pityriasis RoseaAbn Clinical Finding NEC Chalazion Intestinal Disorder NEC Precordial PainAc Tracheitis W/O Obstr Chancroid Iridocyclitis NOS Rectal & Anal HemorrhageAcne NEC Changes in Skin Texture Leg Varicosity w Ulcer Redun Prepuce & PhimosisAcute NOM NOS Chr Ischemic Hrt Dis NOS Mastodynia Referral W/O Exam Or TxAftercare NEC Cor AS-Graft Type NOS Myoclonus Renal/Ureter Disord NOSAphonia Cor AS-Native Vessel NOM NOS Scanty MenstruationArthropathy NOS-Low Leg Ear Disorder NEC Obesity NOS Skin Disorders NECArthropathy NOS-Pelvis Erysipelas OCB W/O Exacerbation Supervis Normal Preg NECAsympt Leg Varicosity Gastric Ulcer NOS Pain in or Around Eye Thrombophlebitis NOSAtroph Gastritis S Hemor Hair Diseases NEC Paralysis Agitans Thyrotox NOS W/O CrisisBackground Retinop NOS Heartburn Paralytic Ileus Urethral CalculusBartholin's Gland Cyst Hemorrhage NOS Patellar Tendinitis Visual Loss NOSCardiac Murmurs NEC Hip Enthesopathy Pilonidal Cyst w AbscessCataract NOS Hordeolum Internum Pilonidal Cyst W/O Absc

NYU Emergency Department Classification100% Emergent - Primary Care Treatable

ICD9 Diagnosis



Emergent - ED Care Needed -Preventable/Avoidable – Emergency department care was required based on the complaint or procedures performed/resources used, but the emergent nature of the condition was potentially preventable/avoidable if timely and effective ambulatory care had been received during the episode of illness (e.g., the flare-ups of asthma, diabetes, congestive heart failure, etc.).



Ac Pyelonephritis NOS DM1 W Ketoacidosis UNCAcute Lung Edema NOS DM2/NOS UNComp UNCAMI NOS-Episode NOS DM2/NOS W Ketoacid NSUAngina Pectoris NEC&NOS DM2/NOS W Ketoacid UNCDM1 UNComp UNC Intermed Coronary SyndDM1 W Ketoacidosis NSU

100% Emergent - Preventable/AvoidableICD9 Diagnosis




Emergent - ED Care Needed - Not Preventable/Avoidable – Emergency department care was required and ambulatory care treatment could not have prevented the condition (e.g., trauma, appendicitis, myocardial infarction, etc.).



2nd Degree A/V Block NEC Cardiac Arrest Hypopotassemia Postabortion GU InfectAB NOS W/O Complication Cereb Art Occl W Infarct Incompl AB NOS W/O Comp Postinflam Pulm FibrosisAbn Blood Chemistry NEC Cerebral Embol W Infarct Inf AMI NEC-Initial Premature Rupt Memb-APAbnormal Feces Chronic Pancreatitis Inferolat AMI-Initial PSVTAc Append w Peritonitis Colon CA NOS Intestinal Adhes w Obstr Pulmonary CongestionAc Respiratory Failure Colon Diverticulitis Intestinal Obstr NOS Purulent Endophthal NOSAcute Appendicitis NOS Colon Diverticulosis Intestine Impaction NEC Rectal & Anal Disord NECAcute Ill-Defined CVD Complete A/V Block Intracerebral Hemorrhage Rectal ProlapseAcute Pancreatitis Digestive Neoplasm NOS Meningitis NOS Subarachnoid HemorrhageAlter Consciousness NEC Disord Cran Nerves NOS Migraine Vrnt NEC W/O Sm Subend Infarct-InitialAMI NOS-Initial Episode Esophageal Dyskinesia Observation Alleged Rape Tachycardia NOSAnal & Rectal Abscess Fetal/NN Jaundice NOS Obstr Hydrocephalus Threat Premat Labor-APAnal or Rectal Pain GI Hemorrhage NOS Obstr Ventral Hernia NOS Thrombocytopenia NOSAnt AMI NEC-Initial Hallucinations Orbital Cellulitis Tracheostomy Comp NECAnterolat AMI-Initial Hematemesis Osteomyelitis NOS-Low LE Trans Cereb Ischemia NOSAppendiceal Abscess Hemoptysis Other Pulmonary Insuff Venous Thrombosis NECAppendicitis NOS Hyperosmolality Pancreas Cyst/Pseudocyst Viral Disease NECAtrial Fibrillation Hyperpotassemia Pneumocystosis Xnodal/NOS Lymphoma NECAtrial Flutter

100% Emergent - Not Preventable/Avoidable ICD9 Diagnosis



Top 10 Primary Care-Related Diagnoses

ICD9 Diagnosis Total

Acute URI NOS 4,148Urinary Tract INF NOS 3,205Acute Bronchitis 3,040Abdominal Pain-Site NOS 3,035Dental Disorder NOS 2,983Asthma NOS W Exacer 2,956Otitis Media NOS 2,835NonINF Gastroent NEC&NOS 2,719Viral Infection NOS 2,691Acute Pharyngitis 2,686Grand Total 30,298

Top 10 Primary Care-Related Diagnoses


Top 10 Primary Care-Related Diagnoses by Demographic Group

ICD9 Diagnosis All Female Male White Black Other Under 18 18 - 64 Over 64

Acute URI NOS 1 2 1 3 1 1 1Urinary Tract INF NOS 2 1 2 9 7 10 6 1Acute Bronchitis 3 4 6 4 7 10 2 5Abdominal Pain-Site NOS 4 3 10 1 8 9 4 7Dental Disorder NOS 5 8 3 5 5 1Asthma NOS W Exacer 6 6 4 2 4 5 8Otitis Media NOS 7 2 10 6 2 2NonINF Gastroent NEC&NOS 8 10 9 10 5 7 10Viral Infection NOS 9 7 3 3 3Acute Pharyngitis 10 7 4 6 4Chest Pain NEC 6 5 3Dizziness & Giddiness 2

Rank by Demographic GroupTop 10 Primary Care-Related Diagnoses


Top 10 Non-Emergent Visits

ICD9 Diagnosis All Female Male White Black Other Under 18 18 - 64 Over 64

Dental Disorder NOS 1 2 1 1 1 5 1Headache 2 3 3 4 4 4 10 3 9Lumbago 3 5 2 5 7 2 7Oth CCE Comp Preg-AP 4 1 2 2 1 4Acute Pharyngitis 5 6 4 3 3 3 3 7Urinary Tract INF NOS 6 4 8 8 9 9 2Pain in Limb 7 8 7 7 7 8 5Viral Infection NOS 8 9 5 6 6 2 2Backache NOS 9 10 6 10 6 8Migraine NOS W/O Sm 10 7 5 5Otitis Media NOS 8 9 9 6 1NonINF Gastroent NEC&NOS 10 10 8 5Dizziness & Giddiness 1

Rank by Demographic GroupTop 10 Non-Emergent Visits

Healthy Capital District Initiative | www.hcdiny.org

Emergent Visits Emergent PreventableVisits

Emergent PrimaryCare Treatable Visits

Non-Emergent Visits0

10

20

30

40

50

60

2008 Emergency Department Primary Care-Related Visits Rates per 1,000

Under 1818-64Over 64

15

17 Healthy Capital District Initiative | www.hcdiny.org

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0%

10%

20%

30%

40%

50%

60%

70%

2008 Emergency Department Primary Care-Related Visits Visits by Race

All BlacksBlacks w/MedicaidBlack FemalesBlack Males

All Whites Whites w/MedicaidWhite FemalesWhite Males

All OtherOthers w/MedicaidOther FemalesOther Males


Private Insurance Medicaid - All Self Pay Medicare Other0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

2008 Emergency Department Primary Care-Related VisitsVisits by Payor Groups

Non-Emergent VisitsEmergent Primary Care Treatable VisitsEmergent Preventable VisitsEmergent Visits

18


Medicaid - All Self Pay Private Insurance Medicare Other0%

10%

20%

30%

40%

50%

60%

70%

2008 Emergency Department Primary Care-Related Visits Percent of Visits by Payor

Non-Emergent VisitsEmergent Primary Care Treatable VisitsEmergent Preventable VisitsEmergent Visits

19


Non-Emergent Emergency Department Utilization by Zip Code Groups

Patient Area

Non-Emergent Visits

Non-Emergent Rate Per 1,000 Rank % Visits Self

Pay% Visits Medicaid

% Visits Medicaid or

Self Pay

Schenectady - Hamilton Hill 1,282 206.5 5 34% 19% 53%Albany - West Hill 3,009 195.4 5 20% 43% 63%Albany - Riverfront/South End 2,158 191.8 5 17% 43% 60%Albany - Arbor Hill/Lark 1,437 155.4 4 18% 42% 60%Schenectady - Goose Hill/Union 1,620 119.6 4 26% 19% 46%Troy/Lansingburgh 7,686 116.8 4 14% 35% 49%Albany - North Albany/Menands 807 114.9 4 14% 23% 37%Schenectady - City/Stockade 585 96.7 3 29% 21% 50%City of Cohoes Total 1,721 96.4 3 15% 29% 44%Schenectady - Upper State Street 1,949 92.3 3 24% 12% 36%Watervliet/Green Island 1,646 85.1 3 15% 26% 42%Albany - Delaware/2nd Ave. 763 72.8 3 17% 27% 44%Albany - Rte. 20/New Scotland 1,343 63.3 3 13% 28% 40%

Areas with Highest Non-Emergent Emergency Department Visit Rates


Non-Emergent Emergency Department Utilization by Zip Code Groups, cont.

Patient Area

Non-Emergent Visits

Non-Emergent Rate Per 1,000 Rank % Visits Self

Pay% Visits Medicaid

% Visits Medicaid or

Self Pay

Schenectady - Hamilton Hill 1,282 206.5 5 34% 19% 53%Schenectady - City/Stockade 585 96.7 3 29% 21% 50%Schenectady - Goose Hill/Union 1,620 119.6 4 26% 19% 46%Schenectady - Upper State Street 1,949 92.3 3 24% 12% 36%Schenectady - Mont Pleasant 1,668 59.2 3 21% 10% 31%Albany - West Hill 3,009 195.4 5 20% 43% 63%Albany - Arbor Hill/Lark 1,437 155.4 4 18% 42% 60%Rotterdam 1,221 45.7 2 18% 7% 26%Albany - Riverfront/South End 2,158 191.8 5 17% 43% 60%Albany - Delaware/2nd Ave. 763 72.8 3 17% 27% 44%Watervliet/Green Island 1,646 85.1 3 15% 26% 42%Cohoes 1,721 96.4 3 15% 29% 44%Albany - North Albany/Menands 807 114.9 4 14% 23% 37%Troy/Lansingburgh 7,686 116.8 4 14% 35% 49%Colonie 1,531 59.1 3 13% 17% 31%Albany - Rte. 20/New Scotland 1,343 63.3 3 13% 28% 40%Rensselaer 1,342 70.1 3 12% 24% 36%

Areas with Highest Emergency Department Self Pay Rates


Preliminary Conclusions

Are emergency departments just for emergencies? No

Does the public distinguish health needs requiring emergent care from primary care?

Not particularlyWho uses the emergency department the most?

Females, minorities, the privately insured, and people living in lower income communities

What are the most common non-emergent uses of the emergency department?

Upper Respiratory Infection, Urinary Tract Infection, Bronchitis, Abdominal Pain, Dental Disorder and Asthma

Where is emergency department use most prevalent? Communities that are closest to EDs, with lower average income, in which using EDs for most health care needs is a cultural norm


Contact

Kevin Jobin-Davis, PhDHealthy Capital District Initiative315 Sheridan Ave.Albany, NY 12206(518) [email protected]/r5.htm

data presentation final web may2010pain in limb 1,421 viral infection nos 1,383 backache nos 1,344...

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