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, DrPH
Department of Community Health at University of Illinois at Urbana-Champaign
SELECTED RESULTS
INTRODUCTION
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 nonurgent 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)
Table 1 - Mean Number of Visits to the ED within the
Previous Year
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
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
Table 5 - Mean Yearly Income
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
Black, non-Hispanic patients had higher mean number visits to the ED (1.41)
Hispanic and Black, non-Hispanic patients reported lower mean annual incomes
than Caucasian patients (1.04).
than White, non-Hispanic patients (see Table 4)
Table 2 - Percentage of Categorized Number of ED Visits
in Previous Year
Race/ethnicity
,p
White Black Hispanic 45.71,
p=0.000
2
0 ED visits
1 ED visit
2 ED visits
3 ED visits
4 ED visits or more
61.0%
18.8%
9.5%
4.0%
6.7%
52.5%
18.4%
11.9%
7.3%
10.0%
Higher percentages of Black, non-Hispanic patients reported they had 2 or more
free clinics helps to offset the financial burden for minorities seeking treatment in
visits to the ED within the previous year
Graph 1 - Urgency of ED Conditions (White, non-Hispanic
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
Lower income
Visits to the ED for non-urgent conditions
Residing in female-headed household
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
LIMITATIONS
Self-reported data
the ED (Isaacs & Jellinek, 2007).
1. Compare ED utilization between minority and non-minority patients
Minority (Black, non-Hispanic)
headed households, and visit the ED for non-urgent care in greater numbers in
81.7%
11.8%
4.3%
2.2%
0.0%
counterparts (Boudreaux, Edmond, Clark, & Camargo, 2003). The existence of
OBJECTIVE
Characteristics of patients with high ED utilization were:
Black, non-Hispanic patients tend to earn lower incomes, reside in female
Visits
The disparity in ED utilization is exacerbated by the cost of care being markedly
CONCLUSIONS
SELECTED RESULTS cont.
Table 3 Percentage for Location of Alternate Healthcare
Location
Race/ethnicity
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/Dont Know 55.0% 49.1% 48.6%
Graph 2 - Urgency of ED Conditions (Black, non-Hispanic
Patients)
Open-ended questions
Insurance coverage not collected on survey instrument
Number of Hispanic and Other patients relatively small
16.4% of Black, non-Hispanic patients reported they would have sought
METHODOLOGY
treatment in the ED for healthcare in the absence of CCCHC in comparison to
14.4% of White, non-Hispanic patients
characteristics and health service utilization (specific focus on ED utilization)
Table 4 - Mean Number of ED Visits in Previous Year by
Female Head of Household
Sample
Race/ethnicity
Demographic Information Form inquired about patients demographic
Data compiled between 2005 and 2007
Female
Head
Frequency
Mean
Surveys were completed by first-time patients at the Champaign County
SD
Christian Health Center, a free health clinic in Champaign, IL (n=971)
Non-Hispanic Black/African American, non-Hispanic White/Caucasian,
White
Hispanic, Other
Statistical analysis
Black
The Statistical Package for Social Sciences (SPSS) was utilized to analyze
the data
A chi-square analysis, bivariate statistical analysis (ANOVA) and generalized
Hispanic
Yes
No
Yes
No
Yes
No
1.09
0.89
1.57
1.36
0.30
0.26
F, p (race/eth)
F, p (f head)
5.48, p<0.001
1.54, p=0.216
2.62
1.98
2.77
3.45
0.65
0.61
linear model were utilized to analyze the data
The majority of White and Black, non-Hispanic patients visited the ED for nonurgent care (67.7% and 76.3%, respectively), with Black, non-Hispanic patients
exhibiting a larger percentage for non-urgent care
FUTURE RESEARCH RECOMMENDATIONS
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
Black, non-Hispanic patients residing in female-headed households
demonstrated higher mean ED visits than White, non-Hispanic patients
coverage
