Emergency department patients who leave before treatment is complete
This retrospective, multicenter study examined all encounters from January 1-December 31, 2019 at 18 EDs. The LBTC patients were divided into left without being seen (LWBS), defined as leaving prior to completed medical screening exam (MSE), and left subsequent to being seen (LSBS), defined as leaving after MSE was complete but before disposition. We recorded 30-day returns by facility type including median return hours, admission rate, and return to index ED. Expected realization rate and potential charges were calculated for each patient visit.
Emergency department (ED) patients who leave before treatment is complete (LBTC) represent medicolegal risk and lost revenue. We sought to examine LBTC return visits characteristics and potential revenue effects for a large healthcare system.
Smalley CM; Meldon SW; Simon EL; Muir McKinsey R; Delgado F; Fertel BS
Western Journal Of Emergency Medicine
2021
2021-02-26
Journal Article
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Inhaled corticosteroid use in asthmatic children receiving Ohio Medicaid: trend analysis, 1997-2001.
Female; Male; Ohio; Child; Infant; United States; Sex Factors; Human; Cross Sectional Studies; Adolescence; Retrospective Design; Regression; Preschool; Newborn; Administration; Inhalation; Ambulatory Care – Statistics and Numerical Data; Emergency Service – Statistics and Numerical Data; Blacks – Statistics and Numerical Data; Whites – Statistics and Numerical Data; Medicaid – Statistics and Numerical Data; Hospitalization – Statistics and Numerical Data; Adrenal Cortex Hormones – Therapeutic Use; Adrenal Cortex Hormones – Administration and Dosage; Asthma – Diagnosis; Asthma – Drug Therapy; Asthma – Ethnology; Drug Utilization – Statistics and Numerical Data; Drug Utilization – Trends
BACKGROUND: In 1997, national guidelines emphasized that inhaled corticosteroids (ICSs) are key therapy for individuals with all classes of persistent asthma, including children. OBJECTIVE: To examine the effect of these guidelines via time-trend analysis of ICS dispensation among children with asthma and Ohio Medicaid insurance. METHODS: A retrospective cross-sectional analysis by yearly cohorts was performed. From January 1, 1997, to December 31, 2001, all children from birth to the age of 18 years with 6 months of Ohio Medicaid enrollment or more, 1 or more asthma diagnoses associated with a provider claim, and 1 or more prescription claims for an asthma medication in a given calendar year were identified using claims data. The daily beclomethasone equivalent (BME) dose, the daily albuterol equivalent dose, and asthma-related health care use were calculated for each child within each yearly cohort. A time-trend regression analysis of subjects enrolled in all 5 years examined factors associated with BME. RESULTS: A total of 77,557 children met the study criteria. Among the 1,475 children enrolled during all 5 years, year of enrollment was a positive independent predictor of BME after adjustment for age, race, sex, systemic steroid bursts, albuterol equivalent dose, and health care use (P \textless .001). CONCLUSIONS: The daily BME dose significantly increased for children with asthma insured by Ohio Medicaid from 1997 to 2001. However, the percentages of children receiving both ICS and a therapeutic BME dose were alarmingly low. The mean BME dose was particularly low among children with 1 or more emergency department visits, no hospitalizations, and 3 or fewer physician visits for asthma per year, suggesting that broader efforts to target this group are needed.
Stevenson MD; Heaton PC; Moomaw CJ; Bean JA; Ruddy RM
Annals of Allergy, Asthma & Immunology
2008
2008-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s1081-1206(10)60049-x" target="_blank" rel="noreferrer noopener">10.1016/s1081-1206(10)60049-x</a>
Patient Insurance Profiles: A Tertiary Care Compared to Three Freestanding Emergency Departments.
Emergency Service; Emergency Service – Statistics and Numerical Data; freestanding emergency department; Health – Statistics and Numerical Data; Health – Trends; Health/*statistics & numerical data/trends; Hospital/*statistics & numerical data; Hospitals; Human; Humans; insurance; Insurance; Medicaid – Statistics and Numerical Data; Medicaid/statistics & numerical data; Medically Uninsured – Statistics and Numerical Data; Medically Uninsured/statistics & numerical data; Medicare – Statistics and Numerical Data; Medicare/statistics & numerical data; Retrospective Design; Retrospective Studies; Special – Statistics and Numerical Data; Tertiary Care Centers/statistics & numerical data; United States; Urban – Statistics and Numerical Data; Urban/*statistics & numerical data
BACKGROUND: It has been speculated that freestanding emergency departments (FEDs) draw more affluent, better-insured patients away from urban hospital EDs. It is believed that this leaves urban hospital-based EDs less financially secure. OBJECTIVE: We examined whether the distribution of patients with four types of insurance (self-pay, Medicaid, Medicare, and private) at the main ED changed after opening three affiliated FEDs, and whether the insurance type distribution was different between main ED and FEDs and between individual FEDs. METHODS: A retrospective analysis of insurance status of all patients presenting to our EDs from July 2006 through August 2013. Insurance was divided into self-pay, Medicare, Medicaid, and private insurance across three time periods, which reflect the sequential opening of each FED. Insurance types for each facility were compared for individual time periods and across time periods. chi(2) was used to analyze the data. RESULTS: In the three studied time frames (periods B, C, and D), there were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main than at each FED (p \textless 0.001). Insurance types were significantly different between each of the three FEDs and the main ED (p \textless 0.001) and between each of the three FEDs (p \textless 0.001). CONCLUSIONS: There were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main ED compared to the FEDs. Privately insured patients decreased at both the FEDs and main ED during the study. Insurance distribution was significantly different between the main ED, and three FEDs, and between individual FEDs.
Simon Erin L; Griffin Gregory; Orlik Kseniya; Jia Zhenyu; Hayslip Dave; Kobe Daniel; Jouriles Nicholas
The Journal of emergency medicine
2016
2016-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jemermed.2016.05.058" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2016.05.058</a>
Characterizing Children Presenting to Three Freestanding EDs.
Adolescence; Adolescent; Age Factors; Child; Emergency Service; Emergency Service – Statistics and Numerical Data; Female; Hospital/*statistics & numerical data; Humans; Infant; Male; Newborn; Preschool; Retrospective Design; Retrospective Studies; Severity of Illness Index; Severity of Illness Indices; Sex Factors; United States
Simon Erin L; Kovacs Mitch; Hayslip Dave; Jouriles Nicholas
The American journal of emergency medicine
2016
2016-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2016.07.060" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2016.07.060</a>