The Impact of an Intervention and Policy Changes on Emergency Department Utilization

This thesis of three studies looked at the impact of one intervention and two policy changes on emergency department (ED) utilization at University of Illinois (UI) Hospital in Chicago, Illinois. Chapter I evaluated the Emergency Patient Interdisciplinary Care (EPIC) program- an individualized care coordination program for frequent ED visitors. Utilizing propensity score matching of the intervention group to a comparison group of similar ED frequent visitors, followed by difference-in-differences analysis of the matched pairs, there was a significant increase in ED visits from before EPIC started to after EPIC for the intervention group, compared to the comparison group. Participants may have felt more satisfied with their care in the ED because of the program. Patients who frequented multiple EDs before the program may have consolidated their care to only the UI Hospital ED after the program. Utilization data across all sites of care could determine if this interpretation of these findings is accurate. Chapter II explored the association between distance to closest federally qualified health center (FQHC) and Medicaid and uninsured patients’ utilization of the ED of UI Hospital for non-urgent needs after an increase in number of FQHCs at the time of the American Recovery and Reinvestment Act. Overall, distance to closest FQHC was not associated with non-urgent ED use. There may be more complexities involved in the decision to use the ED for care versus use a FQHC including quality. Chapter III assessed if the proportion of non-urgent ED utilization changed at UI Hospital after the Affordable Care Act (ACA). Using interrupted time series analysis, results showed that all level changes after ACA were positive and all time trend changes after ACA were negative for non-urgent outcomes using the NYU Algorithm. Medicaid patients had significant positive level changes. Private insurance patients and patients who arrived to the ED during business hours had significant positive level changes and significant negative time trend changes, as well as significant negative level change in having an ESI of 4 or 5 (least urgent) after ACA. Medicaid patients may have been less likely to connect to primary care than other types of patients.