Emergency Department Utilization: Characterization and Comparison of an Urban Elderly Minority and Non-Minority Population

摘要

Background: Emergency departments (ED) are common entry points for the healthcare system among elders. Statistics show higher ED utilization among minority elderly.Objectives: Characterize ED use by elderly minority as compared to non-minority elderly.Setting: Urban Academic EDMethods: Retrospective chart review and prospective telephone survey. Elderly patients were defined as age 65 years or older. Minority groups were defined using U.S. Bureau of Census classifications and included African American, American Indian, Asian, Latino, and Pacific Islander. Results: Three hundred and thirty-two elderly patient charts were reviewed of which 288 (86.7%) were for minority patients and 44 (13.3%) were for non-minority patients. The majority of patients were women (69%) with a mean age of 70.8 ± 6.1. There was a significant difference in the average patient age by race (p=0.008), with the mean age of Caucasians being the highest. A greater percentage of non-minority ED visits were triaged as urgent or emergent as compared with minority groups (79.5% vs. 59.7%, p=0.004) whereas minority patients had a higher incidence of non-urgent triage classifications (34.0% vs. 13.6%, p=0.005). There were no significant differences between the mean number of ED visits between minority and non-minority patients (p=0.40). Despite being Medicare-eligible, more minority patients indicated lack of insurance coverage as the primary reason for seeking emergency care. (p=0.003)Conclusion: Elderly minority patients tended to be slighter younger and seek care from EDs for less urgent conditions than non-minority elderly patients. Race and ethnicity did not appear to be important determinants of emergency departments use. However, these data suggest that interventions that could provide greater access to primary care and preventive services may favorably impact ED utilization among minority elderly. Further investigation into racial and ethnic disparities regarding insurance coverage despite near-universal coverage by Medicare among an elderly population is also warranted.