Emergency Department Visits and Hospitalizations for Ambulatory Care Sensitive Conditions Among Uninsured Hispanics

Trevino, Elizabeth., Emergency Department Visits and Hospitalizations for Ambulatory Care Sensitive Conditions among Uninsured Hispanics. Doctor of Public Health (Health Management and Policy), May 2005, 83 pp., 10 tables, bibliography, 87 titles. Inequalities in access to health care persist in the US health care delivery system and as the number of uninsured patients in the United States continues to increase, emergency departments around the country are becoming inundated with people seeking non-acute, as well as acute medical care. This study explored whether there are differences of emergency department use and hospitalizations for ambulatory care sensitive (ACS) conditions among uninsured Hispanics as compared to other ethnicities using 2001-2002 National Hospital Ambulatory Medical Care Survey (NHAMCS) data. A weighted sample of 4,210,248 emergency department visits for years 2001-2002 was analyzed using frequencies, Pearson x2 tests, logistic regression and multiple logistic regression to determine whether Hispanics and uninsured Hispanic were visiting the emergency department more frequently than any other ethnic group; uninsured Hispanics were being hospitalized due to the severity of the disease; and determine the significant predictors for preventable hospitalizations. Significant differences among the ethnicities studied and emergency department visits during 2001-2002 were found. These differences resulted in favor of African-American. African-American had larger rates of ED visits as compared to Whites and Hispanics. Uninsured African-American were also found as the racial/ethnic group with greater visits for emergency departments. These findings changed when assessing preventable hospitalizations for ACS conditions. A similar direction was found for Whites. Uninsured Hispanics were hospitalized more frequently in triage category less than 15 minutes, indicating the severity of the disease. Age, gender, race/ethnicity and insurance status were found to be significant predictors for preventable hospitalizations. This study revealed a substantial national problem with hospitalizations among uninsured Hispanics that may be prevented with timely and appropriate ambulatory care. The significant finding in this study strongly suggests that although this group did not visit the emergency department as frequently when compared to other ethnicities between 2001-2002, they are doing so when their condition deteriorates to the point to which a visit to the emergency room and hospitalization has become inevitable.