ED Rates Rise When Doctor Offices Are Closed

Patients with problems reaching their primary care practice after hours are more likely to report ending up in the emergency department and going without needed medical care, according to a study by the Center for Studying Health System Change published by Health Affairs.

Funded by the National Institute for Health Care Reform, the study is the first to use a nationally representative sample to describe the U.S. population's access to after-hours care via people's usual primary care practice. In the study, HSC Senior Fellow Ann S. O'Malley, M.D., analyzed data from HSC's 2010 Health Tracking Household Survey related to the 9,577 respondents who reported having a usual source of care.

The study, detailed in a Health Affairs' article titled "After-Hours Access to Primary Care Practices Linked with Lower Emergency Department Use and Less Unmet Medical Need," found that of the 9,577 people with a usual source of care, 1,470 reported trying to contact their primary care practice after hours in the previous 12 months. Of the 1,470 people who tried to contact their practice, 20.8 percent reported it was "very difficult" or "somewhat difficult" to reach a clinician after hours.

After adjusting for age, health status and other factors, the study found that people reporting more difficulty contacting their primary care practice after hours were significantly more likely to report an emergency department visit or going without needed medical care, compared with those who described their after-hours access experience as "not at all difficult" or "not too difficult."

In particular, those who reported more difficulty accessing after-hours care had higher rates of emergency department use — 37.7 percent vs. 30.4 percent for those with less difficulty — and higher rates of unmet medical need — 13.7 percent vs. 6.1 percent.

"The findings indicate that increased support for primary care practices to arrange for accessible after-hours care — whether by phone, email or in person — has the potential to reduce rates of emergency department use and unmet medical needs," O'Malley said.

Other key study findings include:

•  Among people with a usual source of primary care, 40.2 percent reported that their practice offered extended hours, such as at night or on weekends.

•  Children, people in better health, those with private insurance and people using a practice that offers after-hours visits were all less likely to experience difficulty in accessing after-hours care, even after controlling for other factors.


Med Schools, Teaching Hospitals Are Economic Engines


The nation's medical schools and teaching hospitals had a combined economic impact of $587 billion and supported nearly 3.5 million jobs directly or indirectly in 2011, according to an economic impact analysis of AAMC-member institutions by the consulting firm, Tripp Umbach. 

In 2011, one in every 40 wage earners in the United States worked either directly or indirectly for a U.S. medical school or teaching hospital, the report found. Since 2008, the last time the study was conducted, the total employment impact of these institutions increased by 4 percent, a total of 36,831 jobs.

"AAMC member organizations have substantial economic and social impacts on their multi-county regions and within the counties and cities where they have operations. Communities in all regions of the country typically rely on these institutions for job creation, high-quality medical care, advanced research, new business development, and education of medical professionals," the study notes.

AAMC-member institutions also generated more than $34 billion in total state government revenue in 2011 through state income taxes and commerce with local businesses, an increase of $12 billion over 2008.

The total $587 billion economic impact attributable to AAMC-member institutions in 2011 represents a 15 percent increase over 2008. This number includes $255 billion in direct spending, which consists of goods and services and capital improvements, spending by employees and patients as well as their families and visitors, and tax revenues. According to the report, the resulting indirect impact of this spending means that for every dollar spent by a medical school or teaching hospital in 2011, an additional $1.30 was generated.