Factors Leading to an Increased Frequency of ER Visits Among Uninsured Patients With an Established Medical Home

The Emergency Room (ER) is now being used by patients for treatment of routine medical problems, which are not severe enough to warrant an ER visit. From 1994 to 2004 the rate of emergency departments use increased by 6 percent. Lack of transportation and insurance, convenience because of availability of ER during off hours, patients' perception of better care and treatment, lack of primary care infrastructure, increased demand for ERs among minorities and excessive wait times in PHP clinics have been cited as some of the reasons. The objective of the study was to look at factors that were associated with ER use among uninsured adults who already have a medical home. The study uses a retrospective longitudinal design. The sample consisted of a cohort of 1448 adults who were uninsured and who attended a free volunteer clinic during 2009. Clinical and demographic data for these patients were collected during their visit at the clinic using the clinic's EMR system. Data about ER admission for the same group was obtained from the local hospital. The dependent variable was the number of ER visits. Time-series analyses as well as logistic regression models were used. Factors that were evaluated for inclusion in the models among others were age, gender, race/ethnicity, education, residency place, chief complaint during ER visit and income. Conclusion: Perception of the severity of the illness as well as availability of medical services may play an important role in the ER use among the uninsured, despite having a medical home.