Unscheduled Care Access in the United States-A Tale of Two Emergency Departments

Background: Rural communities face challenges in accessing healthcare services due to physician shortages and limited unscheduled care capabilities in office settings. As a result, rural hospital-based Emergency Departments (ED) may disproportionately provide acute, unscheduled care needs. We sought to examine differences in ED utilization and the relative role of the ED in providing access to unscheduled care between rural and urban communities. Methods: Using a 20% sample of the 2012 Medicare Chronic Condition Warehouse, we studied the overall ED visit rate and the unscheduled care rate by geography using the Dartmouth Atlas' hospital referral regions (HRR). We calculated HRR urbanicity as the proportion of beneficiaries residing in an urban zip code within each HRR. We report descriptive statistics and utilize K-means clustering based on the ED visit rates and unscheduled care rates. Results: We found rural ED use is more common and disproportionately the site of unscheduled care delivery when compared to urban communities. The ED visit and. unscheduled care proportions were negatively correlated with increased urbanicity (r = . -0.48, p < 0.001; r = -0.58, p < 0.001). Conclusion: The use and role of EDs by Medicare beneficiaries appears to be substantially different between urban and rural areas. This suggests that the ED may play a distinct role within the healthcare delivery system of rural communities that face disproportionate barriers to care access. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

The study found that rural areas have higher rates of Emergency Department (ED) use compared to urban areas, and the EDs in rural areas are disproportionately providing unscheduled care. As urbanicity increases, ED visit rates and unscheduled care proportions decrease.