Identification of Emergency Care-Sensitive Conditions and Characteristics of Emergency Department Utilization

Abstract

Importance: Monitoring emergency care quality requires understanding which conditions benefit most from timely, quality emergency care. Objectives: To identify a set of emergency care-sensitive conditions (ECSCs) that are treated in most emergency departments (EDs), are associated with a spectrum of adult age groups, and represent common reasons for seeking emergency care and to provide benchmark national estimates of ECSC acute care utilization. Design, Setting, and Participants: A modified Delphi method was used to identify ECSCs. In a cross-sectional analysis, ECSC-associated visits by adults (aged ≥18 years) were identified based on International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes and analyzed with nationally representative data from the 2016 US Nationwide Emergency Department Sample. Data analysis was conducted from January 2018 to December 2018. Main Outcomes and Measures: Identification of ECSCs and ECSC-associated ED utilization patterns, length of stay, and charges. Results: An expert panel rated 51 condition groups as emergency care sensitive. Emergency care-sensitive conditions represented 16033359 of 114323044 ED visits (14.0%) in 2016. On average, 8535261 of 17886220 ED admissions (47.7%) were attributed to ECSCs. The most common ECSC ED visits were for sepsis (1716004 [10.7%]), chronic obstructive pulmonary disease (1273319 [7.9%]), pneumonia (1263971 [7.9%]), asthma (970829 [6.1%]), and heart failure (911602 [5.7%]) but varied by age group. Median (interquartile range) length of stay for ECSC ED admissions was longer than non-ECSC ED admissions (3.2 [1.7-5.8] days vs 2.7 [1.4-4.9] days; P