Revisit Rates and Associated Costs After an Emergency Department Encounter A Multistate Analysis

Background: Return visits to the emergency department (ED) or hospital after an index ED visit strain the health system, but information about rates and determinants of revisits is limited. Objective: To describe revisit rates, variation in revisit rates by diagnosis and state, and associated costs. Design: Observational study using the Healthcare Cost and Utilization Project databases. Setting: 6 U.S. states. Patients: Adults with ED visits between 2006 and 2010. Measurements: Revisit rates and costs. Results: Within 3 days of an index ED visit, 8.2% of patients had a revisit; 32% of those revisits occurred at a different institution. Revisit rates varied by diagnosis, with skin infections having the highest rate. (23.1% [95% Cl, 22.3% to 23.9%]). Revisit rates also varied by state. For skin infections, Florida had higher risk-adjusted revisit rates (24.8% [Cl, 23.5% to 26.2%]) than Nebraska (10.6% [Cl, 9.2% to 12.1%]). In Florida, the only state with complete cost data, total revisit costs for the 19.8% of patients with a revisit within 30 days were 118% of total index ED visit costs for all patients (including those with and without a revisit). Limitation: Whether a revisit reflects inadequate access to primary care, a planned revisit, the patient's nonadherence to ED recommendations, or poor-quality care at the initial ED visit remains unknown. Conclusion: Revisits after an index ED encounter are more frequent than previously reported, in part because many occur outside the index institution. Among ED patients in Florida, more resources are spent on revisits than on index ED visits.