Reena Duseja, MD, MS; Naomi S. Bardach, MD, MAS; Grace A. Lin, MD, MAS; Jinoos Yazdany, MD; Mitzi L. Dean, MS, MHA; Theodore H. Clay, MS; W. John Boscardin, PhD; R. Adams Dudley, MD, MBA
Note: Drs. Duseja and Dudley and Mr. Clay had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Disclaimer: The data presented herein are solely the responsibility of the authors and do not necessarily represent the official views of the Agency for Healthcare Research and Quality.
Grant Support: By the Agency for Healthcare Research and Quality (grant K08HS020667; Dr. Duseja).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1616.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Duseja (e-mail, email@example.com).
Requests for Single Reprints: Reena Duseja, MD, MS, Department of Emergency Medicine, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Duseja, Bardach, Lin, Boscardin, and Dudley; Ms. Dean; and Mr. Clay: University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118.
Dr. Yazdany: Division of Rheumatology, San Francisco General Hospital, 1001 Potrero Avenue, Building 30, Room 3300, San Francisco, CA 94110.
Author Contributions: Conception and design: R. Duseja, N.S. Bardach, M.L. Dean.
Analysis and interpretation of the data: R. Duseja, N.S. Bardach, G.A. Lin, J. Yazdany, M.L. Dean, T.H. Clay, W.J. Boscardin, R.A. Dudley.
Drafting of the article: R. Duseja, G.A. Lin, J. Yazdany, R.A. Dudley.
Critical revision of the article for important intellectual content: R. Duseja, N.S. Bardach, G.A. Lin, J. Yazdany, M.L. Dean, T.H. Clay, W.J. Boscardin, R.A. Dudley.
Final approval of the article: R. Duseja, N.S. Bardach, G.A. Lin, J. Yazdany, M.L. Dean, R.A. Dudley.
Provision of study materials or patients: R. Duseja, R.A. Dudley.
Statistical expertise: R. Duseja, T.H. Clay, W.J. Boscardin.
Obtaining of funding: R. Duseja, R.A. Dudley.
Administrative, technical, or logistic support: R. Duseja, M.L. Dean, R.A. Dudley.
Collection and assembly of data: R. Duseja, N.S. Bardach, R.A. Dudley.
Duseja R, Bardach NS, Lin GA, Yazdany J, Dean ML, Clay TH, et al. Revisit Rates and Associated Costs After an Emergency Department Encounter: A Multistate Analysis. Ann Intern Med. 2015;162:750-756. doi: 10.7326/M14-1616
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Published: Ann Intern Med. 2015;162(11):750-756.
Return visits to the emergency department (ED) or hospital after an index ED visit strain the health system, but information about rates and determinants of revisits is limited.
To describe revisit rates, variation in revisit rates by diagnosis and state, and associated costs.
Observational study using the Healthcare Cost and Utilization Project databases.
6 U.S. states.
Adults with ED visits between 2006 and 2010.
Revisit rates and costs.
Within 3 days of an index ED visit, 8.2% of patients had a revisit; 32% of those revisits occurred at a different institution. Revisit rates varied by diagnosis, with skin infections having the highest rate (23.1% [95% CI, 22.3% to 23.9%]). Revisit rates also varied by state. For skin infections, Florida had higher risk-adjusted revisit rates (24.8% [CI, 23.5% to 26.2%]) than Nebraska (10.6% [CI, 9.2% to 12.1%]). In Florida, the only state with complete cost data, total revisit costs for the 19.8% of patients with a revisit within 30 days were 118% of total index ED visit costs for all patients (including those with and without a revisit).
Whether a revisit reflects inadequate access to primary care, a planned revisit, the patient's nonadherence to ED recommendations, or poor-quality care at the initial ED visit remains unknown.
Revisits after an index ED encounter are more frequent than previously reported, in part because many occur outside the index institution. Among ED patients in Florida, more resources are spent on revisits than on index ED visits.
Agency for Healthcare Research and Quality.
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Emergency Medicine, Hospital Medicine.
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