![]() To assess the appropriateness of ED use at the population level, validated classification methods that use available administrative data will be required.There is renewed interest in understanding emergency department (ED) use patterns in populations, both because of increased use associated with healthcare reform and as private payers seek to stem their rising ED spending.Also, both the original and updated classification tools suggest that, of the 38% of ED visits that are clinically emergent, the majority either do not require ED resources or could have been avoided with better primary care.Ĭonclusions: The updated NYU/JHU-EDA taxonomy appears to offer cogent retrospective inferences about population-level ED utilization. For the first time, we provide a more complete picture of the level of severity among patients treated for injuries within US hospital EDs, with about 86% of such visits being nonsevere. Based on our analyses, it is evident that an even greater number of US ED visits than categorized by the NYU-EDA are nonemergent. Results: Applying the newly developed NYU/JHU-EDA, we classified 99% of visits. We then compared visit distributions across these 2 algorithms and 2 other previous revised versions of the NYU-EDA using our 2 data sources. We termed this new algorithm the NYU/JHU-EDA. Methods: Our Johns Hopkins University (JHU) team classified many uncategorized diagnosis codes into existing New York University Emergency Department Algorithm (NYU-EDA) categories and added 3 severity levels to the injury category. Study Design: Observational study using National Hospital Ambulatory Medical Care Survey ED public use files and hospital billing data for a health plan cohort. Our objectives were to present an expanded and revised version of an existing algorithm and to use this tool to characterize patterns of ED use across US hospitals and within a large sample of health plan enrollees. 1,2 Plans can ensure that members receive appropriate, coordinated primary care to address preventable ED visits.ABSTRACTObjectives: Analyses of emergency department (ED) use require visit classification algorithms based on administrative data. A high rate of ED utilization may indicate poor care management, inadequate access to care or poor patient choices, resulting in ED visits that could be prevented. Some ED events may be attributed to preventable or treatable conditions. Why It MattersĮD visits are a high-intensity service and a cost burden on the health care system, as well as on patients. The observed-to-expected ratio is multiplied by the emergency department visit rate across all health plans to produce a risk-standardized rate which allows for national comparison. The observed and expected rates are used to calculate a calibrated observed-to-expected ratio that assesses whether plans had more, the same or less emergency department visits than expected, while accounting for incremental improvements across all plans over time. Plans report observed rates of ED use and a predicted rate of ED use based on the health of the member population. Advertising and Marketing Your NCQA StatusĪssesses emergency department (ED) utilization among commercial (18 and older) and Medicare (18 and older) health plan members.Virtual Seminars, Webinars and On-demand Training.Health Information Technology Prevalidation Programs. ![]() Population Health Program Accreditation.Managed Behavioral Healthcare Organization (MBHO).Credentials Verification Organization (CVO).Patient-Centered Specialty Practice (PCSP).
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