Emergency Department Care in the United States: A Profile of National Data Sources
Received 13 July 2009; received in revised form 6 November 2009; accepted 20 November 2009. published online 15 January 2010. Corrected Proof
Study objective
Emergency departments (EDs) are an integral part of the US health care system, and yet national data sources on the care received in the ED are poorly understood, thereby limiting their usefulness for analyses. We provide a comparison of data sources that can be used to examine utilization and quality of care in the ED nationally.
The different data sources yielded estimates of the number of EDs that ranged from 4,609 to 4,884 and the number of ED encounters from more than 109 million to more than 116 million. Admission rates across data sources varied from 12.0% to 15.3%. Although comparisons of the 7 data sources were somewhat limited by differences in available information and operational definitions, variation in estimates of utilization and patterns of care existed by region, expected payer, and patient and hospital characteristics. The rankings and estimates of the top 5 first-listed conditions seen in the ED are relatively consistent between the 2 data sources with diagnoses, although the Nationwide Emergency Department Sample estimates 1.3 to 5.8 times more ED visits for each chronic and acute all-listed condition examined relative to the National Hospital Ambulatory Medical Care Survey.
Conclusion
Each of the data sources described in this article has unique advantages and disadvantages when used to examine patterns of ED care, making the different data sources appropriate for different applications. Analysts should select a data source according to its construction and should bear in mind its strengths and weaknesses in drawing conclusions based on the estimates it yields.
aCenter for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD
Address for correspondence: Ryan Mutter, PhD, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850; 301-427-1415, fax 301-427-1430
The views expressed in this article are those of the authors and do not necessarily represent those of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.
Supervising editor: Robert L. Wears, MD, MS
Author contributions: PLO, RMW, and RMA conceived and designed the study. MLB and TBG implemented the study design under the direction of PLO and RLM. MLB, TBG, PLO, and RLM designed the analytic plan and analyzed the data. PLO, MLB, TBG, and RLM drafted the manuscript, and all authors contributed substantially to its revision. RLM and PLO take responsibility for the paper.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. The work on which this article is based was supported by the Agency for Healthcare Research and Quality under contract number (HHSA-290-2006-00009-C).
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