For many minority patients, the emergency department (ED) serves as a primary

healthcare facility. Minorities represent more than half of the uninsured population

(Cardelli & Chiapa, 2007). Although many uninsured patients utilize the ED for non-

urgent care, privately insured patients do not frequent the ED for care (Khaliq &

Broyles, 2006). Utilization of EDs is not based solely on race or ethnicity.

Additional factors include:

 

income (Suruda, Burns, Knight, & Dean, 2005)

insurance status (Todd, Armon, Griggs, Poole, & Berman, 2006)

access to primary care (Cardelli & Chiapa, 2007)

cost of care (Baker & Baker, 1994)

 

The disparity in ED utilization is exacerbated by the cost of care being markedly

more expensive than the cost of care in a primary healthcare setting (Baker &

Baker, 1994; Machlin, 2006; Newton, Keirns, Cunningham, Haywood, & Stanley,

2008). The high cost of care places a financial strain on minority patients (Cheong,

Feeley, & Servoss, 2007) who reportedly earn lower incomes than their White

counterparts (Boudreaux, Edmond, Clark, & Camargo, 2003). The existence of

free clinics helps to offset the financial burden for minorities seeking treatment in

the ED (Isaacs & Jellinek, 2007).

Is access to primary care the solution we have been searching for regarding emergency department utilization differences between minority and non-minority patients?

Marquianna Griffin, MSPH; Stephen Notaro, PhD; I. Shevon Harvey, DrPHDepartment of Community Health at University of Illinois at Urbana-Champaign

INTRODUCTION

Black, non-Hispanic patients had higher mean number visits to the ED (1.41)

than Caucasian patients (1.04).

OBJECTIVE

METHODOLOGY

SELECTED RESULTS CONCLUSIONS

LIMITATIONS

FUTURE RESEARCH RECOMMENDATIONS

1. Compare ED utilization between minority and non-minority patients

2. Identify which factors contribute to minority patients utilizing the ED in greater

numbers than their non-minority counterparts

3. Discuss accessible primary care as a solution for patients utilizing the ED for

their healthcare needs

Demographic Information Form inquired about patients’ demographic

characteristics and health service utilization (specific focus on ED utilization)

Sample

Data compiled between 2005 and 2007

Surveys were completed by first-time patients at the Champaign County

Christian Health Center, a free health clinic in Champaign, IL (n=971)

Non-Hispanic Black/African American, non-Hispanic White/Caucasian,

Hispanic, Other

Statistical analysis

The Statistical Package for Social Sciences (SPSS) was utilized to analyze

the data

A chi-square analysis, bivariate statistical analysis (ANOVA) and generalized

linear model were utilized to analyze the data

Location Race/ethnicity χ 2, p

White Black Hispanic 37.72, p=0.000

Hospital 12.8% 11.4% 11.4%

Emergency Room 14.4% 16.4% 5.7%

Community Health Ctrs 12.2% 15.0% 28.6%

Other Healthcare 5.6% 8.2% 5.7%

Nowhere/Don’t Know 55.0% 49.1% 48.6%

Visits Race/ethnicity χ 2, p

White Black Hispanic 45.71, p=0.000

0 ED visits 61.0% 52.5% 81.7%

1 ED visit 18.8% 18.4% 11.8%

2 ED visits 9.5% 11.9% 4.3%

3 ED visits 4.0% 7.3% 2.2%

4 ED visits or more 6.7% 10.0% 0.0%

Race/ethnicity Frequency F, p

Mean SD 5.88, p=0.001

White 1.04 2.62

Black 1.41 2.95

Hispanic 0.27 0.66

Race/ethnicity Frequency F, p

Mean SD 3.07, p=0.027

White $11,005.58 $10,702.00

Black $8,050.00 $10,704.09

Hispanic $10,044.55 $10,376.87

Characteristics of patients with high ED utilization were:

Minority (Black, non-Hispanic)

Lower income

Visits to the ED for non-urgent conditions

Residing in female-headed household

Black, non-Hispanic patients tend to earn lower incomes, reside in female

headed households, and visit the ED for non-urgent care in greater numbers in

comparison to their White, non-Hispanic counterparts

Access to primary care can

Reduce the number of patients visiting the ED for their primary care

Potentially reduce the economic strain on the healthcare system resulting

from low-income patients that incur ED cost for their primary care

The existence of free health clinics provides a primary healthcare alternative to

the ED

Self-reported data

Open-ended questions

Insurance coverage not collected on survey instrument

Number of Hispanic and “Other” patients relatively small

Future studies should collect data on healthcare utilization and insurance

coverage to determine if uninsured minorities frequent the ED because they lack

insurance coverage

If data is utilized in free clinic setting:

Questions should provide concrete responses for data analysis

Medical records should be utilized for diagnosis as opposed to self-reported

reason for visit

Research instrument should ask patients if they have insurance coverage

Analysis should study relationships between ED utilization and insurance

coverage

Higher percentages of Black, non-Hispanic patients reported they had 2 or more

visits to the ED within the previous year

16.4% of Black, non-Hispanic patients reported they would have sought

treatment in the ED for healthcare in the absence of CCCHC in comparison to

14.4% of White, non-Hispanic patients

Hispanic and Black, non-Hispanic patients reported lower mean annual incomes

than White, non-Hispanic patients (see Table 4)

The majority of White and Black, non-Hispanic patients visited the ED for non-

urgent care (67.7% and 76.3%, respectively), with Black, non-Hispanic patients

exhibiting a larger percentage for non-urgent care

Race/ethnicity Female Head

Frequency F, p (race/eth)F, p (f head)

Mean SD 5.48, p<0.0011.54, p=0.216

White Yes 1.09 2.62

No 0.89 1.98

Black Yes 1.57 2.77

No 1.36 3.45

Hispanic Yes 0.30 0.65

No 0.26 0.61

Table 1 - Mean Number of Visits to the ED within the Previous Year Table 5 - Mean Yearly Income

Black, non-Hispanic patients residing in female-headed households

demonstrated higher mean ED visits than White, non-Hispanic patients

Table 4 - Mean Number of ED Visits in Previous Year by Female Head of Household

Table 2 - Percentage of Categorized Number of ED Visits in Previous Year

Table 3 – Percentage for Location of Alternate Healthcare

SELECTED RESULTS cont.

Graph 1 - Urgency of ED Conditions (White, non-Hispanic Patients)

Graph 2 - Urgency of ED Conditions (Black, non-Hispanic Patients)