| The purpose of this study was to explain medically unnecessary emergency department (ED) use among a cohort of Medicaid recipients enrolled in CareOregon, a Medicaid-only managed care organization serving the Oregon Health Plan population. It was hypothesized that demographic characteristics, barriers to primary care, patient health behaviors, satisfaction with primary care providers, and self-assessed health status help to explain medically unnecessary ED use. Increased understanding of these factors can guide policy development and delivery system reform in appropriate ways. Medically unnecessary use of ED services is widely regarded as being expensive, result in duplicative tests and hospital admissions, and may result in a lack of timely, comprehensive, and appropriate follow-up care.;Medicaid recipients are now increasingly enrolled in managed care organizations with the goal being improved access to primary care services and decreased medically unnecessary use of emergency services. Existing research on ED utilization has focused on visits without distinguishing between medically necessary and unnecessary use patterns. Further, the term "unnecessary" has not been examined from a consumers' perspective. The innovative CareOregon Healthwise Evaluation study provided a unique opportunity to study this issue. It evaluated the effect the Healthwise Handbook has on service utilization within five Multnomah County primary care clinic populations enrolled in CareOregon. The evaluation study also matched self-reported health status, utilization preferences, and self-care belief information with CareOregon utilization data for an eighteen-month period. Linear regression models were developed. These models described CareOregon members who seek medically unnecessary ED care rather than seeking care at a Multnomah County primary care clinic for non-emergent conditions. The analysis also identified the demographic and psycho-social characteristics of CareOregon members that predict who will use the ED for medically unnecessary conditions.;Access emerged as an important indicator of ED use. This suggested that the emergency systems, rather than medicaid clients, should adjust their approaches to caring for this population. ED's need to modify their definitions of accessibility to accommodate medicaid clients who will continue to use ED's for non-urgent purposes. By making these adjustments, ED's would provide inclusive treatment which would result in the efficient delivery of services to Medicaid clients. |
