Determining Patient Barriers Affecting Emergency Room Overutilization at Northeast Georgia Medical Center Open Access

Oberste, Anna (2014)

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Background: Emergency departments are currently experiencing crowding, long wait times, and significant strain on the staff, and are targeting over utilizers as a way to divert care into more appropriate care settings. Northeast Georgia Hospital System (NGHS) Emergency Department, the busiest in the state has developed extensive community healthcare settings but continues to have returning over utilizers which taxes their already limited resources.

Method: This study used an existing emergency room survey instrument modified to determine the perceived barriers to utilizing community healthcare options. Emergency department patient database was applied to identify the over utilizers, reasons for visits and statistical patterns for emergency department use.

Results: Of those surveyed the most common barriers were associated with perceived cost of community care, and lack of awareness of community options. Fifty-two percent cited appointment barriers, inability to get an appointment which fit their schedule or find an available appointment time in a timely manner. Twenty-nine percent said that transportation was a problem. Other barriers to community care include healthcare urgency perceptions by the patient, medication compliance, health literacy, and cultural norms.

Conclusion: Over utilizers perceived barriers to community healthcare are similar to national trends. Even though patients may have access to primary care, they often feel that their community health care does not meet their health goals. On the other hand, these patients feel the emergency department does provide for their health needs with respect to relief, convenience, cost, and resolution of acute exacerbations.

Table of Contents

Table of Contents

Table of Contents...1
Glossary of Terms...4
Chapter 1: Introduction...6

Problem Statement...6
Theoretical Framework...7
Purpose Statement...9
Research Question...9


Chapter 2: Literature Review...11

Characteristics of Frequent ED Users...11

Population Characteristics...11
Health Literacy...15
Perceived Barriers to Community Care...17
Evidence-Based Interventions for Frequent and Super Users of the ED...20


Table 1. Characteristics of ED Frequent Users and Super Users...26
Table 2. Interventions for Frequent Users of the ED...28

Chapter 3: Methodology...30

Population and Sample...30
Research Design...30
Data Analysis...32
Limitation and Delimitations...33
Emory University Institutional Review Board Clearance...33

Chapter 4: Results...35


Figure 1. Frequency of NGHS ED visits, October 1, 2013 to April 30, 2014, per individual patient. Inset: expanded scale for patients with ≥6 visits...36
Table 3: Patient characteristics, October 1, 2013 through April 30, 2014...37
Table 4: Most common diagnoses codes for all ED visits...38
Figure 2 Frequency of return visits for the same or a similar complaint, derived from admission diagnosis ICD-9 codes. A. All patients. B. Patients who visited ≥6 times...38
Figure 3 Temporal trends in NGHS ED visits, for all patients. A. Count by day of week. B. Frequency by hour of day...39

Interview Findings...39

Figure 4 Results for attempts to contact frequent NGHS ED users...40
Figure 5 Patient-reported frequency of ED (A) and doctor visits (B), and number of doctors seen (C) in the 90 days prior to their latest ED visit...41
Figure 6. Reasons doctor was not seen...41

Other Findings...42



Chapter 5: Discussion...44

Summary of Study...44


Appendix A: Mixed Method Analysis of ED Frequent Users at Northeast Georgia Hospital System...51
Appendix B: Northeast Georgia Medical Center Emergency Room Follow-up Survey...52
Appendix C Formulas for Excel Statistics...55
Appendix D: EPI-Info Statistical Analysis of Survey...59


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