Potentially Preventable Emergency Room (ED) Visits Travis County - PowerPoint PPT Presentation

Potentially Preventable Emergency Room (ED) Visits Travis County July 15, 2013 0

Integrated Care Collaboration (ICC) • Non-profit alliance of health care safety-net providers in Central Texas (Austin area)  Multi-hospital systems  Public and private clinics  Federally qualified health centers  City public health clinics • Maintains a fully operational Health Information Exchange (HIE) system  Database called ICare 1 ICare Data, May 2012 - April 2013

Methodology/Definitions • ICare Only Data Source used in this study • Timeframe: May 2012 – April 2013 • Patient’s County of Residence Travis • ICare patients aged 18-64 years  At this time 65+ excluded due to lack of Medicare data in ICare However, plans in process to add this payer • Chronic and Behavioral Health Dx are defined by the Healthcare Costs and Utilization Project (HCUP) Clinical Classifications Software for ICD-9-CM http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp  Codes related to tobacco use have been excluded as BH Dx 2 ICare Data, May 2012 - April 2013

Methodology/Definitions • There are two types of Behavioral Health classifications in the analysis • BH Patient: Patients are classified as BH patients if they had a BH diagnosis (as defined by HCUP) at any clinic, ED, IP, or OP encounter during the timeframe • BH-Related ED Encounter/Visit: BH encounters are classified as ED encounters in which a BH diagnosis (as defined by HCUP) was assigned at the encounter in any position. To be classified a BH-Related ED encounter, the BH diagnosis did not have to be the primary diagnosis • The list of ICD-9 codes defined by HCUP as Mental Illness is more inclusive than the list of ICD-9 codes classified by the NYU algorithm as ‘Mental Health Related’. Because we used HCUP to define these groups and we looked at more than just the primary diagnosis, there are more ED encounters identified as BH-Related then are identified as Mental Health Related by the NYU algorithm 3 ICare Data, May 2012 - April 2013

Methodology/Definitions • Definitions:  Medical Home: 2 consecutive clinic visits to the same organization in 18 months  Clinic Non-User: ED patients with no clinic visit within timeframe  Clinic User: ED patients with a clinic visit • Payor Grouping Payor Plan Name Payor Plan Name Seton Charity BFAP Charity St. David's Charity CHIP County Indigent Central Health MAP Other County Jail CSHCN Travis County Jail Medicaid FFS Medicare Medicaid Medicaid MC Medicare MC Other Seton Pending Assistance Other/Unknown Edgar B Davis Self Pay Project Access Seton CCHC SFS SSI Pending Seton Care Plus TX Other Self Pay Seton Musicians Seton Pending Assistance Seton Self Pay VA St. David's Self Pay Workers Comp 4 ICare Data, May 2012 - April 2013

Key Findings • 57.3% of visits for the time period were potentially preventable • Patients with Behavioral Health Dx at any encounter are less likely to have a potentially preventable ED visit • Behavioral Health or Chronic Dx at ED encounter less likely to be a potentially preventable ED visit  The ED rate among Behavioral Health patients is 1.67 times greater than the ED rate among non-Behavioral Health patients • Non-Users of clinic have higher proportion of self pay in payor mix • Distance to a clinic or hospital does not seem to be a factor 5 ICare Data, May 2012 - April 2013

Facts • Study  55,549 Unique Patients  99,591 ED Encounters  57,105 or 57.3% Potentially Preventable ED visits  37,811 ED Encounters for Clinic Users during timeframe  30,033 ED Encounters for active Medical Home Patients % Encounters Encounters Total ED Encounters 99,591 Potentially Preventable 57,105 57.3% Non-Emergent 29,630 29.8% Emergent, Primary Care Treatable 23,650 23.7% Emergent, ED Care Needed, Preventable/ Avoidable 3,825 3.8% Emergent, ED Care Needed, Not Preventable/ Avoidable 11,960 12.0% Injury 15,705 15.8% Mental Health Related 2,363 2.4% Alcohol Related 2,021 2.0% Drug Related (excluding alcohol) 257 0.3% Not in a Special Category, and Not Classified 10,181 10.2% 6 ICare Data, May 2012 - April 2013

ED Encounter Demographics - Age 2.0 Unique Patients 43,757 13.7% 1.8 42,976 40,000 1.6 Unique Patients/ED Encounters 18-30 Years 43.2% 31-50 Years 1.4 51-64 Years 1.2 43.0% Rate 24,019 23,909 1.0 20,000 0.8 ED Encounters 12.9% 0.6 12,858 0.4 7,621 18-30 Years 43.9% 31-50 Years 0.2 51-64 Years 0 0.0 43.2% 18-30 Years 31-50 Years 51-64 Years Unique Patients ED Encounters Rate • Age ranges of patients in the study are predominantly split between the 18-30 and 30-50 ranges (each being about 43% of all patients) 7 ICare Data, May 2012 - April 2013

ED Encounter Demographics - Gender 60,000 2.0 Unique Patients 57,376 1.8 1.6 Female 45.2% Unique Patients/ED Encounters 42,215 54.8% Male 1.4 40,000 1.2 30,430 Rate 1.0 ED Encounters 25,119 0.8 20,000 0.6 42.4% Female Male 57.6% 0.4 0.2 0 0.0 Female Male • Female patients have the highest rate of ED Unique Patients ED Encounters Rate encounters per patient 8 ICare Data, May 2012 - April 2013

ED Encounter Demographics – Race/Ethnicity 60,000 2.0 Unique Patients 11.9% 1.8 51,058 Black 35.7% 50,000 1.6 Hispanic Unique Patients/ED Encounters Other 1.4 White 40,000 48.1% 4.4% 1.2 33,355 Rate 30,000 1.0 ED Encounters 26,720 11.8% 0.8 19,805 33.5% 20,000 Black 0.6 Hispanic 11,739 Other 0.4 10,000 White 3.5% 6,587 51.3% 0.2 3,439 2,437 0 0.0 Hispanic White Black Other • Hispanic patients have the highest rate of ED Unique Patients ED Encounters Rate encounters per patient 9 ICare Data, May 2012 - April 2013

ED Encounter Demographics – Behavioral Health 80,000 3.00 Unique Patients 67,042 22.6% 2.50 Unique Patients/ED Encounters 60,000 BH - Yes 2.00 BH- No 43,009 Rate 77.4% 40,000 1.50 32,549 ED Encounters 1.00 20,000 12,540 32.7% 0.50 BH - Yes BH- No 0 0.00 BH - Yes BH- No 67.3% Unique Patients ED Encounters Rate • BH Patient: Patients are classified as BH patients if they had a BH diagnosis (as defined by HCUP) at any clinic, ED, IP, or OP encounter during the timeframe • The ED rate among Behavioral Health patients is 1.67 times greater than the ED rate among non-Behavioral Health patients 10 ICare Data, May 2012 - April 2013

Top 5 Frequent Primary Diagnosis Codes for ED Visit Age 18-30 648.93 OT CURRENT COND ANTEPARTUM 789.09 ABDOM PAIN OT/MULTI SITE 784.0 HEADACHE 789 ABDOM PAIN UNSP SITE 729.5 PAIN IN LIMB Age 31-50 789.09 ABDOM PAIN OT/MULTI SITE • Abdominal Pain and Pain in 784.0 HEADACHE Limb are frequent primary 729.5 PAIN IN LIMB diagnoses in all age groups 786.2 COUGH 724.2 LUMBAGO Age 51-64 729.5 PAIN IN LIMB 789.09 ABDOM PAIN OT/MULTI SITE 786.2 COUGH 784.0 HEADACHE 786.5 UNSPECIFIED CHEST PAIN 11 ICare Data, May 2012 - April 2013

ED Encounters by Day and Time of Week • ED visits peak daily between 11:00 am and noon 12

ED Encounter Demographics # ED Visits Patients w/ 1-2 ED Visits Patients w/ 3+ ED Visits Encounters Percent Encounters Percent TOTAL 46,272 100.0 9,277 100 Age 18-30 Years 20,071 43.4 3,948 42.6 31-50 Years 19,818 42.8 4,091 44.1 51-64 Years 6,383 13.8 1,238 13.3 Race/Ethnicity White 17,062 36.9 2,743 29.6 Black 5,411 11.7 1,176 12.7 Hispanic 21,581 46.6 5,139 55.4 Other 2,218 4.8 219 2.4 5 Most Common Primary Diagnoses 1 ABDOM PAIN OT/MULTI SITE (489.09) PAIN IN LIMB (729.5) 2 HEADACHE (784.0) ABDOM PAIN OT/MULTI SITE (489.09) 3 PAIN IN LIMB (729.5) HEADACHE (784.0) 4 COUGH (486.2) COUGH (486.2) 5 ABDOM PAIN UNSP SITE (789.00) OT CURRENT COND ANTEPARTUM (648.93) • Clinic Hours defined as 8am – 6pm 13 ICare Data, May 2012 - April 2013

ED Encounter Demographic Summary • Age ranges of patients in the study are predominantly split between the 18-30 and 30-50 ranges (each being about 43% of all patients) • Abdomen Pain and Pain in Limb frequent primary diagnosis in all age groups • 55% Female, while overall ICare 55.0% • 48.1% Hispanic, while overall ICare 42.7% • Hispanic patients have the highest rate of ED encounters per patient • The ED rate among Behavioral Health patients is 1.67 times greater than the ED rate among non-Behavioral Health patients • Behavioral Health patients accounted for 22.6% of patients and 32.7% of encounters 14 ICare Data, May 2012 - April 2013

Patient Proximity to Nearest Facility Clinic User Clinic Non-User • Only hospitals and clinics Encounters Percent Encounters Percent that submit data to the ICC TOTAL 14,834 100.0 29,796 100.0 were included in distance Nearest Facility calculations Clinic 13,343 89.9 25,373 85.2 Hospital 1,491 10.1 4,423 14.8 • Includes Travis County Distance to Clinic 3 residents whose exact <1 mi 6,408 43.2 11,723 39.3 address within Travis County 1-1.99 mi 4,944 33.3 9,800 32.9 was able to be geocoded 2-4.99 mi 2876 19.4 6794 22.8 5-9.99 mi 501 3.4 1247 4.2 • Distance was calculated to 10+ mi 105 0.7 232 0.8 the nearest Family Practice Distance to Hospital 4 clinic <1 mi 1,184 8.0 2,823 9.5 1-1.99 mi 2,290 15.4 4,948 16.6 • Dell Children's Hospital was 2-4.99 mi 9,065 61.1 17,462 58.6 excluded from distance 5-9.99 mi 1,861 12.5 3,664 12.3 calculations 10+ mi 434 2.9 899 3.0 • Distance to facility does not seem to be a factor 15 ICare Data, May 2012 - April 2013