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HOUSTON HOSPITALS
EMERGENCY DEPARTMENT USE STUDY
January 1, 2005 through December 31, 2005
FINAL REPORT
Prepared By
School of Public Health
University of Texas Health Science Center at Houston
Charles Begley, Patrick Courtney, Keith Burau, Thomas Reynolds
March 2007
2
TABLE OF CONTENTS
I. Executive Summary ....................................................................................... 3
II. Purpose .......................................................................................................... 13
III. Methods ......................................................................................................... 14
IV. Results ........................................................................................................... 18
ED Visits by Type……………………………..…………………………….18
Summary
Tables and Figures
ED Visits by Month, Day of Week, and Time of Day……………………..21
Summary
Tables and Figures
Primary Care-Related ED Visits by Patient Characteristics……….…….25
Summary
Tables and Figures
Health Conditions of Patients with Primary and
Non-Primary Care-Related Visits………..…………………………….34
Summary
Tables and Figures
Geographic Distribution of Patients with
Primary Care-Related Visits………….…..…………....……………....37
Summary
Maps
V. 2002-2005 Comparison………………………………….…………………..50 Summary
Tables and Figures
3
I. EXECUTIVE SUMMARY
Houston/Harris County hospitals’ emergency departments have become major providers
of primary care, particularly for low-income uninsured people unable or unwilling to access
basic medical services at private or public clinics or doctor’s offices. The University Of Texas
School Of Public Health has been collecting and analyzing emergency department visit data in
Harris County hospitals to monitor primary care-related use of the emergency department. This
report provides an analysis of 2005 ED visit data and describes trends over the last four years.
Data and Analysis
Twenty five hospitals which have emergency departments (EDs) and provide a
substantial amount of discounted and free care to the uninsured of Harris County have provided
ED visit data for the year 2005. They include: two hospitals of the Harris County Hospital
District (Ben Taub General and Lyndon B. Johnson General); nine hospitals of the Memorial
Hermann Health Care System (Hermann/Texas Medical Center, Southwest, Southeast,
Northeast, Northwest, The Woodlands, Memorial City, Katy, and Sugar Land); four hospitals of
the Hospital Corporation of America, or HCA (Bayshore Medical Center, Spring Branch
Medical Center, East Houston Regional Medical Center, and West Houston Medical Center); St.
Joseph Medical Center; two Doctors Hospitals (Tidwell and Parker); Texas Children’s Hospital;
two hospitals of CHRISTUS Gulf Coast (St. Catherine and St. John); two hospitals of St. Luke’s
(Episcopal Hospital and Community Medical Center); and two hospitals of the Methodist
Hospital System (Methodist/Texas Medical Center and San Jacinto Methodist).
4
Each hospital supplied the following data elements on all ED visits that were made
during the period January 1, 2005 through December 31, 2005:
1. Date and time of admission to ED
2. Primary and secondary discharge diagnosis
3. Discharge date and time
4. Payment source
5. Patient age
6. Patient gender
7. Patient race/ethnicity
8. Patient ZIP code
9. Where discharged to (e.g. home, nursing home, etc.)
Visits that resulted in an admission (discharged to hospital) were eliminated. The
probability that each nonadmitted visit was one or more of the following types of visits was
assigned based on applying the New York University ED Algorithm to the discharge diagnosis.
1. Non-emergent: Immediate treatment was not required within 12 hours.
2. Emergent-Primary Care Treatable: Treatment was required within 12 hours, but
could have been provided effectively and safely in a primary care setting.
Continuous observation was not required, no procedures were performed or
resources used that are not typically available in a primary care setting.
3. Emergent-ED Care Needed-Preventable/Avoidable: ED care was required within
12 hours, but the emergent nature of the condition was potentially preventable/
avoidable if timely/continuous primary care had been received for the underlying
illness.
4. Emergent-ED Care Needed-Not Preventable/Avoidable: ED care was required
within 12 hours and primary care could not have prevented the condition.
The frequencies of visits for each diagnosis were multiplied by their respective probabilities
of visit type and then the number of visit types was aggregated for all diagnoses to produce estimates
of the total number of ED visits by type. ED visits in the first three categories are considered
primary care-related use of the ED. Those in the fourth category reflect non-primary care-related
use of the ED. The time and geographic pattern of primary care and non-primary care-related ED
visits are summarized in the report. In addition, the demographic, coverage, and health conditions
5
of patients with primary care and non-primary care-related visits are shown. The Executive
Summary and main body of the report present 2005 information for twenty five hospitals. The
comparison of data for the years 2002 through 2005 is for eleven hospitals for which four years of
data are available.
2005 Results
1. Total ED Visits (non hospitalized) by Type
♦ During 2005, 879,333 ED visits were made to these 25 hospitals. This represents
69.4% of the 1,267,588 ED visits to all Harris County hospitals. Of this number,
727,797 ED visits were non hospitalized. Of this number, 664,177 non hospitalized
ED visits were made by Harris County residents, representing 75.5% of total ED
visits to these hospitals.
♦ 53.6% of all ED visits by Harris County residents were primary care-related. This
represents 82.6% of categorizable ED visits (Table 1).
♦ Just over one fifth of all ED visits (21.7%) were non-emergent (Table 1). A slightly
higher percentage (23.7%) were primary care treatable. This represents 33.4% and
36.5% respectively, of categorizable visits (Table 1).
♦ 153,521 ED visits (23.1% of total ED visits) were injuries, and 14,073 ED visits
(2.1% of total) were either mental health, alcohol, or drug related (Table 1).
2. ED Visits by Month, Day, and Time
• ED visits by Harris County residents declined during the year, peaking in January at
roughly 42,000, with September the lowest month at 32,000 (Figure 2). Primary
care-related ED visits followed roughly the same pattern.
6
• There was little variation in the number of total ED visits by day of the week, with a
slight peak on Thursday. The same held true for primary care-related ED visits
(Figure 3).
• The smallest number of ED visits were between the hours of 3 AM and 5 AM, the
most were between the hours of 11 AM and 8 PM (with peaks at 11 AM, 6 PM, and 8
PM). Primary care-related ED visits followed a similar pattern (Figure 4). It should be
noted that the largest volume of primary care-related ED visits took occurred during
hours in which physicians’ offices and outpatient clinics would normally be open.
3. Primary Care-Related ED Visits by Patient Characteristics
• 32.9% of primary care-related visits were by patients who were uninsured, 30.8% had
Medicaid, 24.8% had private insurance, and 8.6% had Medicare (Figure 5).
• 33.1% of primary care-related visits were by Blacks, 35.2% Hispanics, 25.6%
Whites, 2.4 Other, and 1.2% Asian (Figure 6).
• 54.7% of primary care-related visits were by adults age 18-64, 38.3% were children
and youth age 0-17, and 7.1% were adults aged 65 or older (Figure 7).
• 57.7% of primary care-related visits were by females and 42.3% were by males
(Figure 8).
• Patients with Medicaid had the highest proportion of ED visits that were primary
care-related (87.3%), with patients on Medicare having the lowest proportion at
76.5%. 83.8% of ED visits by the uninsured were primary care-related (Figure 9).
• Race/ethnicity groups with the highest proportion of visits primary care-related were
Blacks (84.9%) and Hispanics 83.5% (Figure 10).
7
• The proportion of visits that were primary care-related declined with age: 88.2% for
children age 17 and younger, 80.1% for adults age 18 to 64, and 74.7% for adults age
65 and over (Figure 11).
• There was almost no variation by gender for proportion of visits that were primary
care-related (Figure12).
4. Health Conditions of Patients with Primary and Non-Primary Care-Related Visits
• The five most frequent diagnoses of patients with primary care-related visits were:
acute upper respiratory infection not otherwise specified, otitis media not otherwise
specified, fever, urinary tract infection not otherwise specified, and noninfectious
gastroenteritis (Table 4). A comparison with the ED report using the 2004 data shows
the same top results, although in a slightly different order.
• The five most frequent diagnoses of patients with non-primary care related ED visits
were chest pain not otherwise specified, abdominal pain unspecified site, chest pain
(other), fever, and syncope and collapse (Table 5). As above, this list is nearly
identical to the comparable list using the 2004 ED data.
5. Geographic Distribution of Patients with Primary Care-Related Visits
• ED visits were mapped according to both frequency and rate. Rates were based on
2005 population and on 2005 insurance enrollment. The ZIP codes of 77010 and
77046 were excluded from the rate maps for having populations below 2,000.
Insurance rates were grouped into three categories: a) persons who were uninsured
(based on 2005 estimates), b) persons who were enrolled in Medicaid (based on fall
2005 Medicaid enrollment), and c) non-Medicaid insured (the remainder, primarily
8
consisting of the privately insured and those covered by Medicare). It was not feasible
to disaggregate the non-Medicaid insured rate.
• Overall ED visits, primary care related ED visits in general, primary care related ED
visits by persons who were uninsured, and primary care related ED visits by persons
who were enrolled in Medicaid were made most often by residents of the following
ZIP code clusters (in clockwise order): 1) Aldine/Fifth Ward/northeast section of the
610 loop (both inside and outside the loop); 2) the Ship Channel; 3) Galena Park and
parts of Pasadena; 4) Third Ward and South Park/central and southern part of the 610
loop; 5) southwestern/Alief/Sharpstown area; 6) Bear Creek/intersection of interstate
10 and highway 6; and 7) Acres Homes/Spring Branch (Maps 1, 2, 3, and 4).
• Primary care related ED visits by the non-Medicaid insured came from many of the
same areas, but also from suburban areas such as Katy, Pearland, Friendswood, and
The Woodlands (Map 5).
• When examined in terms of population rates, the areas with the highest rates of
overall ED visits, primary care related ED visits in general, and primary care related
ED visits by the uninsured are the east/northeast and south central areas of Harris
County (Maps 6, 7, and 8).
• When examined in terms of insurance rates, the east/northeast section of Harris
County – particularly along the Ship Channel – continued to show the highest rate of
primary care related ED visits, regardless of payer source (Maps 9, 10, and 11). South
central Harris County had a high rate of primary care related ED visits both for
persons who were uninsured and for persons who were non-Medicaid insured (Maps
9 and 11). The Woodlands area showed a high rate of primary care related ED visits
9
for persons on Medicaid (Map 10), and the Katy area showed a high rate of primary
care related ED visits for anyone with some form of insurance coverage (Maps 10 and
11).
2002-2005 Comparison
ED visits in eleven hospitals (Ben Taub General, LBJ General, Memorial Hermann Texas
Medical Center, Memorial Hermann Southwest, Memorial Hermann Southeast, Memorial
Hermann Northwest, Memorial Hermann The Woodlands, Memorial Hermann Memorial City,
Memorial Hermann Katy, Memorial Hermann Sugar Land, and St. Joseph Medical Center)
increased from 465,909 in 2002 to 485,882 in 2003, and decreased by 2005 to 381,339 (Table 6).
The percentage of total visits that were primary care related rose from 52.1% in 2002 to 54.2% in
2005 of total visits and from 81.5% in 2002 to 83.1% of categorized visits in 2005. Among
classified visits, there was a slight increase in non emergent cases from 2002 to 2004, followed
by a slight drop in 2005.
Commercial or private insurance has continued to decline as a payer source of
primary care related ED visits, with Medicaid holding fairly steady for the last three
years. The uninsured continue to figure predominantly in the payer mix (Figure 13).
There has been an increase in the number of primary care related ED visits
by Hispanics and a decrease in the number by Whites. There has been some fluctuation
among Blacks but Blacks continue to have the greatest proportion of primary care
related ED visits (Figure 14).
Except for a slight increase among those age 18-64 in 2004, there has been almost
no variation by age from 2002 to 2005 (Figure 15). There has been no change in the gender
10
ratio (Figure 16).
11
Conclusions
Even though the 2004 study included data from 16 hospitals and the 2005 study included
data from 25 hospitals – a more than 50% increase in the number of participating hospitals –
certain trends remain constant: 1) More than eight out of ten categorized ED visits are primary
care related (83.1% in 2004 and 82.6% in 2005). 2) The peak hour for total ED visits and
primary care related ED visits is midmorning. This is a time at which outpatient clinics would
normally be open. 3) More than three out of ten primary care related ED visits are by those who
are uninsured. 4) Roughly seven out of ten primary care related ED visits are by persons who are
Black or Hispanic. 5) Just under four out of ten primary care related ED visits are by children
age 17 or younger, and more than half of primary care related ED visits are by female patients.
What has changed somewhat in the current analyses is the geographical distribution
of where patients who make primary care related ED visits reside. This, of course, is due to the
addition of hospitals at different locations in Harris County. Distribution by frequency of primary
care related ED visits by the uninsured has shown a slightly different pattern than in last year’s
report, and the distribution by population rate has more sharply distinguished the east/northeast
and south central sections of Harris County with a high rate of primary care related ED visits by
the uninsured (Maps 8 and 9). What remains striking is that the east/northeast section of the
county remains prominent even when analyses are done separately for rates of primary care ED
visits by payer source (Maps 9, 10, and 11). Participation by a greater number of hospitals has
allowed for a fuller picture of the nature and distribution of primary care related ED visits. This
in turn can allow for more effective planning and policy making, in areas such as where to
expand outpatient capacity, patient education about when to use an ED, etc.
12
Note:
Although Hurricane Katrina brought a large influx of people into the greater
Houston area in late 2005, such patients were not included in this analysis. These
analyses only dealt with residents of Harris County ZIP codes.
The ED algorithm does not classify mental health, drug/alcohol, and
injury visits. It is likely that a large percentage of such visits are unavoidable emergency
department visits.
13
II. PURPOSE
The increasing number of hospital emergency department visits, many of which are
primary care-related, is leading to a multitude of associated issues regarding equity and access to
care in the U.S. One of the most pressing issues in Houston is the capacity of hospitals to
provide emergency care when emergency rooms are crowded with patients seeking basic care.
The main purpose of this study is to provide information on the frequency, type, and distribution
of ED visits in Houston hospitals that are primary care-related. To achieve this purpose, the
study obtained ED data from twenty five hospitals in Houston for 2005, classified the visits of
Harris County residents in terms of primary care-related/non-primary care-related use of the ED,
and examined the demographic, coverage, and geographic characteristics of patients making the
visits. The goal is to replicate the study over time in order to determine trends and evaluate
primary care enhancement activities.
14
III. METHODS
The study initially resulted from a partnership between Gateway to Care, the Harris
County Hospital District (HCHD), and The University of Texas School of Public Health
(UTSPH). In 2002, UTSPH worked with Gateway to Care on a pilot study to develop a process
for monitoring ED use in Houston. The process developed in the pilot study was then applied to
11 hospitals in 2002. Data were obtained from these hospitals and two others in 2003. In 2004,
data was collected from an additional three hospitals. The current report, using data from 25 of
the hospitals that serve the Houston 911 service area, is the most extensive report of the last four
years. Aggregate reports for each year are posted on the website for the Health Services
Research Collaborative.
The first step in the study involves requesting the following information on ED visits in
Houston hospitals:
1. Date and time of admission to ED
2. Primary and secondary discharge diagnosis
3. Discharge date and time
4. Payment source (payer codes from the Patient Data Set of the Texas Hospital
Association and the Texas Health Care Information Council)
5. Patient age
6. Patient gender
7. Patient race/ethnicity (Black, Asian, American Indian, Hispanic, White, Other,
Unknown)
8. Patient ZIP code
9. Where discharged to (e.g. home, hospital, etc)
Working with the hospitals, a dataset was obtained, reviewed, and cleaned comprising a full set
of ED visit information for the period January 1, 2005 – December 31, 2005. All visits that did
not result in hospitalization were eliminated, as were visits by individuals from outside of Harris
County.
15
The second step involved the application of the New York University ED Classification
Algorithm to classify ED visits of Harris County residents into the following four categories:
1. Non-emergent: Immediate treatment was not required within 12 hours.
2. Emergent-Primary Care Treatable: Treatment was required within 12 hours, but
could have been provided effectively and safely in a primary care setting.
Continuous observation was not required, no procedures were performed or
resources used that are not typically available in a primary care setting.
3. Emergent-ED Care Needed-Preventable/Avoidable: ED care was required within
12 hours, but the emergent nature of the condition was potentially
preventable/avoidable if timely/continuous primary care had been received for the
underlying illness.
4. Emergent-ED Care Needed-Not Preventable/Avoidable: ED care was required
within 12 hours and primary care could not have prevented the condition.
The NYU Center for Health and Public Service Research and the United Hospital Fund
of New York developed the ED Algorithm as a measure of primary care-related ED use. The ED
Algorithm is a set of probabilities that when applied to the primary diagnosis (ICD-9 code) of the
patient estimates the likelihood that the patient’s ED visit was one or more of the types described
above. The ED algorithm was developed with the advice of a panel of ED physicians and is
based on information abstracted from a sample of complete ED records – 3,500 cases in 1994
and 2,200 cases in 1999 – from six Bronx, New York hospitals. The decision tree followed by
the panel is summarized on the next page.
The distribution of ED visits by type represents the weighted sum of all visits with a
certain probability of being that type. ED visits in the first three categories are considered
primary care-related use of the ED, while those in the fourth category reflect non-primary care-
related use of the ED. A number of visits are not categorized using the Algorithm. These
include injury, mental health-related, and alcohol or drug-related visits, and visits with missing
data. The ED Algorithm for these visits has not yet been developed by the NYU researchers.
16
Various analyses were conducted of the classified visit data to determine patterns of
primary care-related and non-primary care-related visits. These included monthly, daily, and
time of day patterns of visits; the distribution of visits by the coverage and demographic
characteristics of patients (payment source, race/ethnicity, age, employment status, and sex); the
distribution of visits by primary diagnosis (ICD9 Codes); and the distribution of visits by patient
residence using geo-coded maps.
The results of the analysis of ED visits should be treated cautiously and are best viewed
as indicators of utilization rather than a definitive assessment. This is because only a portion of
all visits that did not result in a hospitalization are collected and only a subset of those visits is
categorized by the Algorithm. ED visits that result in a hospital admission usually encompass no
more than 10-20% of total visits.1 Presumably such visits would not fall into primary care-
related categories nor would most injury visits that are not categorized. Given these limitations
1 Billings J, Using administrative data to monitor access, identify disparities, and assess
performance of the safety net, U.S. Agency for Healthcare Research and Quality, 2003.
Emergent
Non-emergent
ED Care Needed
Primary Care Treatable
Primary Care Treatable
Not Preventable/Avoidable
Preventable/Avoidable
Step 1 Steps 2 and 3 Step 4
ED CLASSIFICATION PROCESS
17
in the methods, the percentage of visits that fall into the primary care-related categories should
be interpreted as a conservative estimate and may underestimate the true value in the population.
18
IV. RESULTS
ED Visits by Type
During 2005, 879,333 ED visits were made to these 25 hospitals. This represents 69.4%
of the 1,267,588 ED visits to all Harris County hospitals. Of this number, 727,797 ED visits were
non hospitalized. Of this number, 664,177 non hospitalized ED visits were made by Harris
County residents, representing 75.5% of total ED visits to these hospitals.
53.6% of all ED visits by Harris County residents were primary care-related. This
represents 82.6% of categorizable ED visits (Table 1).
Just over one fifth of ED visits (21.7%) were non-emergent (Table 1). A slightly higher
percentage (23.7%) were primary care treatable. This represents 33.4% and 36.5% respectively,
of categorizable visits (Table 1).
153,521 ED visits (almost one fourth) were injuries, and 14,073 ED visits (2.`% of total)
were either mental health, alcohol, or drug related (Table 1).
19
Table 1. 2005 ED visits at All Hospitals (N=25) by Harris County Residents
Type of Visit All
Number 25
CATEGORIZED VISITS
Non-Emergent 144,137
Emergent, Primary Care Treatable 157,172
Emergent, ED Care Needed - Preventable/Avoidable 54,684
Total Primary Care Related Visits 355,992
Emergent, ED Care Needed - NOT Preventable/Avoidable 75,020
Total Categorized Visits 431,012
NON-CATEGORIZED ED VISITS
Injury 153,521
Mental Health Related 9,437
Alcohol or Drug Related 4,636
Unclassified 65,571
Total Non-Categorized Visits 233,165
Total Visits 664,177
Percent
DETAIL - CATEGORIZED ED VISITS
Non-Emergent 33.4%
Emergent - Primary Care Treatable 36.5%
ED Care Needed - Prev./Avoid. 12.7%
% Total Primary Care Related 82.6%
ED Care Needed - NOT Prev./Avoid. 17.4%
TOTAL ED VISITS
Non-Emergent 21.7%
Emergent - Primary Care Treatable 23.7%
ED Care Needed - Prev./Avoid. 8.2%
% Total Primary Care Related 53.6%
ED Care Needed - NOT Prev./Avoid. 11.3%
% Categorized ED Visits 64.9%
Injury 23.1%
Mental Health Related 1.4%
Alcohol or Drug Related 0.7%
Unclassified 9.9%
% All Visits 100.0%
20
Figure 1. Percentage of Categorized ED Visits by Type (N=25)
Emergent, ED
Care Needed -
NOT Preventable/
Avoidable
17.4%
Emergent, ED
Care Needed -
Preventable/
Avoidable. 12.7%
Non-Emergent.
33.4%
Emergent,
Primary Care
Treatable. 36.5%
21
ED Visits by Month, Day of Week, and Time of Day
ED visits by Harris County residents peaked in January at roughly 42,000, with
September being the lowest month at 32,000 (Figure 2). Primary care-related ED visits in
particular followed roughly the same pattern.
There was little variation in the number of total ED visits by day of the week, with a
slight peak on Thursday. The same held true for primary care-related ED visits (Figure 3).
The smallest number of ED visits were between the hours of 3 AM and 5 AM, the most
were between the hours of 11 AM and 8 PM (with peaks at 11 AM, 6 PM, and 8 PM). Primary
care-related ED visits followed a similar pattern (Figure 4). It should be noted that the largest
volume of primary care-related ED visits took occurred during hours in which physicians’
offices and outpatient clinics would normally be open.
22
Fig
ure
2
23
Fig
ure
3
24
Fig
ure
4
25
Primary Care-Related ED Visits by Patient Characteristics
32.9% of primary care-related visits were by patients who were uninsured, 30.8% had
Medicaid, 24.8% had private insurance, and 8.6% had Medicare (Figure 5).
33.1% of primary care-related visits were by Blacks, 35.2% Hispanics, 25.6% Whites,
2.4 Other, and 1.2% Asian (Figure 6).
54.7% of primary care-related visits were by adults age 18-64, 38.3% were children and
youth age 0-17, and 7.1% were adults aged 65 or older (Figure 7).
57.7% of primary care-related visits were by females and 42.3% were by males (Figure
8).
Patients with Medicaid had the highest proportion of ED visits that were primary care-
related (87.3%), with patients on Medicare having the lowest proportion at 76.5%. 83.8% of ED
visits by the uninsured were primary care-related (Figure 9).
Race/ethnicity groups with the highest proportion of visits primary care-related were
Blacks (84.9%) and Hispanics 83.5% (Figure 10).
The proportion of visits that were primary care-related declined with age: 88.2% for
children age 17 and younger, 80.1% for adults age 18 to 64, and 74.7% for adults age 65 and
over (Figure 11).
There was almost no variation by gender for proportion of visits that were primary care-
related (Figure 12).
26
Tab
le 2
. E
D V
isit
Types
by C
over
age
and D
emo
gra
phic
Char
acte
rist
ics
of
Pat
ients
(N
=25)
T
yp
e o
f V
isit
Re
ad H
orizo
nta
lly
Co
mm
M'c
aid
M'c
are
Oth
er
Go
v.
Oth
er
Pri
v.
Un
ins
Un
kA
llC
om
mM
'ca
idM
'ca
reO
th.
Go
v
Oth
.
Pri
vU
nin
sU
nis
&
M'c
aid
No
n-E
me
rge
nt
35
,08
14
2,5
22
10,7
20
2,5
80
1,4
01
50
,510
1,3
23
144
,13
72
4.3
%2
9.5
%7
.4%
1.8
%1.0
%3
5.0
%6
4.5
%
Em
erg
en
t-P
rim
ary
Care
Tre
ata
ble
40
,039
50
,27
212
,85
42
,79
37
114
9,9
63
540
157
,17
22
5.5
%3
2.0
%8
.2%
1.8
%0.5
%3
1.8
%6
3.8
%
Em
erg
en
t C
are
Ne
ede
d-P
rev
enta
ble
/Av
oid
able
13,1
1116
,77
86,8
82
1,08
817
916
,506
140
54,6
83
24.0
%3
0.7
%12
.6%
2.0
%0.3
%3
0.2
%6
0.9
%
To
tal
Pri
ma
ry C
are
Re
late
d8
8,2
30
109
,57
13
0,4
56
6,4
61
2,2
92
116
,97
92
,00
33
55
,99
22
4.8
%3
0.8
%8
.6%
1.8
%0
.6%
32
.9%
63
.6%
Em
erg
en
t C
are
Ne
ed
ed
-NO
T P
rev
en
tab
le/A
vo
ida
ble
24
,73
115
,90
19,3
75
1,47
83
93
22
,646
495
75
,019
33
.0%
21.
2%
12.5
%2
.0%
0.5
%3
0.2
%5
1.4
%
TO
TA
L C
ate
go
rize
d V
isits
112
,96
112
5,4
72
39,8
31
7,9
39
2,6
85
139
,625
2,4
98
431,
011
26.2
%2
9.1
%9
.2%
1.8
%0.6
%3
2.4
%6
1.5
%
TO
TA
L A
ll V
isits
182
,65
717
2,7
26
64,9
1613
,94
112
,27
02
11,5
07
6,1
60
664
,17
72
7.5
%2
6.0
%9
.8%
2.1
%1.8
%3
1.8
%5
7.9
%
As
ian
Bla
ck
His
p.
Am
. In
dia
nO
the
rU
nk
Wh
ite
All
As
ian
Bla
ck
His
p.
Am
.
Ind
ian
Oth
er
Un
kW
hit
eB
lk.
&
His
p.
No
n-E
me
rge
nt
1,8
30
48
,85
95
0,7
63
97
3,5
59
3,5
33
35
,49
614
4,1
37
1.3
%3
3.9
%3
5.2
%0.1
%2.5
%2
.5%
24.6
%69
.1%
Em
erg
en
t-P
rim
ary
Care
Tre
ata
ble
1,8
37
50
,010
57,1
54
94
3,7
95
3,9
05
40
,37
615
7,1
72
1.2
%3
1.8
%3
6.4
%0.1
%2.4
%2
.5%
25.7
%68
.2%
Em
erg
en
t C
are
Ne
ede
d-P
rev
enta
ble
/Av
oid
able
58
219
,04
117
,23
133
1,17
81,
311
15,3
09
54,6
84
1.1%
34
.8%
31.5
%0.1
%2.2
%2
.4%
28.0
%66
.3%
To
tal
Pri
ma
ry C
are
Re
late
d4
,24
911
7,9
1012
5,1
48
22
48
,53
28
,74
99
1,18
13
55
,99
21.
2%
33
.1%
35
.2%
0.1
%2
.4%
2.5
%2
5.6
%6
8.3
%
Em
erg
en
t C
are
Ne
ed
ed
-NO
T P
rev
en
tab
le/A
vo
ida
ble
1,12
82
1,0
03
24
,74
85
01,
87
81,
83
22
4,3
80
75
,02
01.
5%
28
.0%
33
.0%
0.1
%2
.5%
2.4
%3
2.5
%6
1.0
%
TO
TA
L C
ate
go
rize
d V
isits
5,3
77
138,9
1314
9,8
96
274
10,4
1010
,581
115
,56
14
31,
012
1.2
%3
2.2
%3
4.8
%0.1
%2.4
%2
.5%
26.8
%67
.0%
TO
TA
L A
ll V
isits
8,9
71
20
1,14
92
25
,06
64
22
16,1
96
16,6
53
195
,72
06
64
,17
71.4
%3
0.3
%3
3.9
%0.1
%2.4
%2
.5%
29.5
%64
.2%
0-1
718
-64
65
+A
ll0
-17
18-6
46
5+
No
n-E
me
rge
nt
52
,159
83
,23
38,7
45
144,1
37
36.2
%5
7.7
%6
.1%
Em
erg
en
t-P
rim
ary
Care
Tre
ata
ble
62
,947
83
,43
710
,78
815
7,1
72
40.0
%5
3.1
%6
.9%
Em
erg
en
t C
are
Ne
ede
d-P
rev
enta
ble
/Av
oid
able
21,
067
27
,89
65,7
20
54
,68
43
8.5
%5
1.0
%10
.5%
To
tal
Pri
ma
ry C
are
Re
late
d13
6,1
73
194
,56
72
5,2
52
35
5,9
92
38
.3%
54
.7%
7.1
%
Em
erg
en
t C
are
Ne
ed
ed
-NO
T P
rev
en
tab
le/A
vo
ida
ble
18,1
54
48
,30
58,5
61
75
,02
02
4.2
%6
4.4
%11
.4%
TO
TA
L C
ate
go
rize
d V
isits
154
,32
72
42,8
72
33,8
134
31,0
123
5.8
%5
6.3
%7
.8%
TO
TA
L A
ll V
isits
22
5,5
77
38
2,8
05
55,7
95
66
4,1
77
34.0
%5
7.6
%8
.4%
Fe
ma
leM
ale
Un
kA
llF
em
ale
Ma
leU
nk
No
n-E
me
rge
nt
86
,415
57
,714
814
4,1
37
60.0
%4
0.0
%0
.0%
Em
erg
en
t-P
rim
ary
Care
Tre
ata
ble
89
,452
67,7
119
157,1
72
56.9
%4
3.1
%0
.0%
Em
erg
en
t C
are
Ne
ede
d-P
rev
enta
ble
/Av
oid
able
29
,583
25
,09
92
54
,68
45
4.1
%4
5.9
%0
.0%
To
tal
Pri
ma
ry C
are
Re
late
d2
05
,44
915
0,5
24
193
55,9
92
57
.7%
42
.3%
0.0
%
Em
erg
en
t C
are
Ne
ed
ed
-NO
T P
rev
en
tab
le/A
vo
ida
ble
43
,427
31,
58
85
75
,02
05
7.9
%4
2.1
%0
.0%
TO
TA
L C
ate
go
rize
d V
isits
24
8,8
76
182,1
122
44
31,0
125
7.7
%4
2.3
%0
.0%
TO
TA
L A
ll V
isits
36
4,10
93
00,0
20
48
66
4,1
77
54.8
%4
5.2
%0
.0%
PA
YM
EN
T S
OU
RC
E
AG
E
GE
ND
ER
RA
CE
/ET
HN
ICIT
Y
27
Figure 5. Primary Care Related ED Visits by Payment Source (N=25)
Medicaid
30.8%
Uninsured
32.9%
Medicare
8.6%
Oth. Gov
1.8%
Oth. Priv
0.6%
Private
24.8%
Figure 6. Primary Care Related ED Visits by Race/Ethnicity (N=25)
Black, 33.1%White, 25.6%
Asian, 1.2%
Unk, 2.5%
Other, 2.4%
Am. Indian, 0.1%
Hispanic, 35.2%
28
Figure 7. Primary Care Related ED Visits by Age (N=25)
0-17, 38.3%
18-64, 54.7%
65+, 7.1%
Figure 8. Primary Care Related ED Visits by Gender (N=25)
Female, 57.7%
Male, 42.3%
29
Tab
le 3
. C
over
age
and D
emogra
phic
Char
acte
rist
ics
of
Pat
ients
by E
D V
isit
Type
(N=
25
)
Vis
it T
yp
es
Co
mm
.M
'caid
M'c
are
Oth
er
Go
v.
Oth
er
Pri
v.
Un
ins.
Un
kA
llC
om
m.
M'c
aid
M'c
are
Oth
er
Go
v.
Oth
er
Pri
v.
Un
insu
red
All
Non-E
merg
ent
35,0
81
42,5
22
10,7
20
2,5
80
1,4
01
50,5
10
1,3
23
144,1
37
31.1
%33.9
%26.9
%32.5
%52.2
%36.2
%33.4
%
Em
erg
ent-
Prim
ary
Care
Tre
ata
ble
40,0
39
50,2
72
12,8
54
2,7
93
711
49,9
63
540
157,1
72
35.4
%40.1
%32.3
%35.2
%26.5
%35.8
%36.5
%
Em
erg
ent C
are
Needed-P
rev.
/Avo
id.
13,1
11
16,7
78
6,8
82
1,0
88
179
16,5
06
140
54,6
83
11.6
%13.4
%17.3
%13.7
%6.7
%11.8
%12.7
%
To
tal P
rim
ary
Care
Rela
ted
88,2
30
109,5
71
30,4
56
6,4
61
2,2
92
116,9
79
2,0
03
355,9
92
78.1
%87.3
%76.5
%81.4
%85.4
%83.8
%82.6
%
Em
erg
en
t C
are
Need
ed
-NO
T P
rev./A
vo
id.
24,7
31
15,9
01
9,3
75
1,4
78
393
22,6
46
495
75,0
19
21.9
%12.7
%23.5
%18.6
%14.6
%16.2
%17.4
%
TO
TA
L C
lass
ified V
isits
112,9
61
125,4
72
39,8
31
7,9
39
2,6
85
139,6
25
2,4
98
431,0
11
26.2
%29.1
%9.2
%1.8
%0.6
%32.4
%100.0
%
TO
TA
L A
ll V
isits
182,6
57
172,7
26
64,9
16
13,9
41
12,2
70
211,5
07
6,1
60
664,1
77
27.5
%26.0
%9.8
%2.1
%1.8
%31.8
%100.0
%
Asia
nB
lack
His
p.
Am
. In
d.
Oth
er
Un
kW
hit
eA
llA
sia
nB
lack
His
p.
Am
. In
d.
Oth
er
Un
kW
hit
eA
ll
Non-E
merg
ent
1,8
30
48,8
59
50,7
63
97
3,5
59
3,5
33
35,4
96
144,1
37
34.0
%35.2
%33.9
%35.3
%34.2
%33.4
%30.7
%33.4
%
Em
erg
ent-
Prim
ary
Care
Tre
ata
ble
1,8
37
50,0
10
57,1
54
94
3,7
95
3,9
05
40,3
76
157,1
72
34.2
%36.0
%38.1
%34.3
%36.5
%36.9
%34.9
%36.5
%
Em
erg
ent C
are
Needed-P
rev.
/Avo
id.
582
19,0
41
17,2
31
33
1,1
78
1,3
11
15,3
09
54,6
84
10.8
%13.7
%11.5
%12.0
%11.3
%12.4
%13.2
%12.7
%
To
tal P
rim
ary
Care
Rela
ted
4,2
49
117,9
10
125,1
48
224
8,5
32
8,7
49
91,1
81
355,9
92
79.0
%84.9
%83.5
%81.7
%82.0
%82.7
%78.9
%82.6
%
Em
erg
en
t C
are
Need
ed
-NO
T P
rev./A
vo
id.
1,1
28
21,0
03
24,7
48
50
1,8
78
1,8
32
24,3
80
75,0
20
21.0
%15.1
%16.5
%18.3
%18.0
%17.3
%21.1
%17.4
%
TO
TA
L C
lass
ified V
isits
5,3
77
138,9
13
149,8
96
274
10,4
10
10,5
81
115,5
61
431,0
12
1.2
%32.2
%34.8
%0.1
%2.4
%2.5
%26.8
%100.0
%
TO
TA
L A
ll V
isits
8,9
71
201,1
49
225,0
66
422
16,1
96
16,6
53
195,7
20
664,1
77
1.4
%30.3
%33.9
%0.1
%2.4
%2.5
%29.5
%100.0
%
0-1
718-6
465+
All
0-1
718-6
465+
All
Non-E
merg
ent
52,1
59
83,2
33
8,7
45
144,1
37
33.8
%34.3
%25.9
%33.4
%
Em
erg
ent-
Prim
ary
Care
Tre
ata
ble
62,9
47
83,4
37
10,7
88
157,1
72
40.8
%34.4
%31.9
%36.5
%
Em
erg
ent C
are
Needed-P
rev.
/Avo
id.
21,0
67
27,8
96
5,7
20
54,6
84
13.7
%11.5
%16.9
%12.7
%
To
tal P
rim
ary
Care
Rela
ted
136,1
73
194,5
67
25,2
52
355,9
92
88.2
%80.1
%74.7
%82.6
%
Em
erg
en
t C
are
Need
ed
-NO
T P
rev./A
vo
id.
18,1
54
48,3
05
8,5
61
75,0
20
11.8
%19.9
%25.3
%17.4
%
TO
TA
L C
lass
ified V
isits
154,3
27
242,8
72
33,8
13
431,0
12
35.8
%56.3
%7.8
%100.0
%
TO
TA
L A
ll V
isits
225,5
77
382,8
05
55,7
95
664,1
77
34.0
%57.6
%8.4
%100.0
%
Fem
ale
Male
Un
kn
ow
nA
llF
em
ale
Male
All
Non-E
merg
ent
86,4
15
57,7
14
8144,1
37
34.7
%31.7
%33.4
%
Em
erg
ent-
Prim
ary
Care
Tre
ata
ble
89,4
52
67,7
11
9157,1
72
35.9
%37.2
%36.5
%
Em
erg
ent C
are
Needed-P
rev.
/Avo
id.
29,5
83
25,0
99
254,6
84
11.9
%13.8
%12.7
%
To
tal P
rim
ary
Care
Rela
ted
205,4
49
150,5
24
19
355,9
92
82.6
%82.7
%82.6
%
Em
erg
en
t C
are
Need
ed
-NO
T P
rev./A
vo
id.
43,4
27
31,5
88
575,0
20
17.4
%17.3
%17.4
%
TO
TA
L C
lass
ified V
isits
248,8
76
182,1
12
24
431,0
12
57.7
%42.3
%100.0
%
TO
TA
L A
ll V
isits
364,1
09
300,0
20
48
664,1
77
54.8
%45.2
%100.0
%
PA
YM
EN
T S
OU
RC
Ere
ad v
ert
ically
AG
E
SE
X
RA
CE
/ET
HN
ICIT
Y
30
Fig
ure
9. P
aym
ent
Sourc
e b
y E
D V
isit
Typ
e (N
25
)
31.1
%33.9
%26.9
%32.5
%
52.2
%
36.2
%33.4
%
35.4
%
40.1
%
32.3
%
35.2
%
26.5
%
35.8
%36.5
%
11.6
%
13.4
%
17.3
%
13.7
%
6.7
%11.8
%12.7
%
21.9
%12.7
%
23.5
%18.6
%14.6
%16.2
%17.4
%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% C
omm
erc.
Med
icai
d
Med
icar
e
Oth
er G
ov.
Oth
er P
riv.
Unin
sure
d
All
Em
erg
ent
Care
Needed-
NO
T P
rev.
/Avo
id.
Em
erg
ent
Care
Needed-
Pre
v./A
void
.
Em
erg
ent-
Prim
ary
Care
Tre
ata
ble
Non-E
merg
ent
31
Fig
ure
10. R
ace/
Eth
nic
ity b
y E
D V
isit
Type
(N=
25)
34.0
%35.2
%33.9
%35.3
%34.2
%33.4
%30.7
%33.4
%
34.2
%36.0
%38.1
%34.3
%36.5
%36.9
%34.9
%36.5
%
10.8
%13.7
%11.5
%12.0
%11.3
%12.4
%13.2
%12.7
%
21.0
%15.1
%16.5
%18.3
%18.0
%17.3
%21.1
%17.4
%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Asi
an
Bla
ck
His
panic
Am
.Indi
an
Oth
er
Unk
White
All
Em
erg
ent
Care
Needed-
NO
T P
rev.
/Avo
id.
Em
erg
ent
Care
Needed-
Pre
v./A
void
.
Em
erg
ent-
Prim
ary
Care
Tre
ata
ble
Non-E
merg
ent
32
Fig
ure
11. A
ge
by E
D V
isit
Type
(N=
25)
33.8
%34.3
%
25.9
%33.4
%
40.8
%34.4
%
31.9
%
36.5
%
13.7
%
11.5
%
16.9
%
12.7
%
11.8
%19.9
%25.3
%17.4
%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0-1
718-6
465+
All
Em
erg
ent
Care
Needed-
NO
T P
rev.
/Avo
id.
Em
erg
ent
Care
Needed-
Pre
v./A
void
.
Em
erg
ent-
Prim
ary
Care
Tre
ata
ble
Non-E
merg
ent
33
Fig
ure
12. G
ender
by E
D V
isit
Type
(N=
25)
34.7
%31.7
%33.4
%
35.9
%37.2
%36.5
%
11.9
%13.8
%12.7
%
17.4
%17.3
%17.4
%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Fem
ale
Male
All
Em
erg
ent
Care
Needed-
NO
T P
rev.
/Avo
id.
Em
erg
ent
Care
Needed-
Pre
v./A
void
.
Em
erg
ent-
Prim
ary
Care
Tre
ata
ble
Non-E
merg
ent
34
Health Conditions of Patients with Primary and Non-Primary Care-Related Visits
The five most frequent diagnoses of patients with primary care-related visits
were: acute upper respiratory infection not otherwise specified, otitis media not otherwise
specified, fever, urinary tract infection not otherwise specified, and noninfectious
gastroenteritis (Table 4). A comparison with the ED report using the 2004 data shows the
same top results, although in a slightly different order.
The five most frequent diagnoses of patients with non-primary care related ED
visits were chest pain not otherwise specified, abdominal pain unspecified site, chest pain
(other), fever, and syncope and collapse (Table 5). As above, this list is nearly identical to
the comparable list using the 2004 ED data.
35
Table 4. Most Frequent Conditions of Patients with Primary Care Related ED Visits (N=25)
Obs Icd COUNT Description
1 4659 19,264 acute uri nos
2 3829 14,219 otitis media nos
3 7806 13,211 fever
4 5990 11,933 urin tract infection nos
5 5589 11,853 noninf gastroenterit nec
6 462 9,848 acute pharyngitis
7 7840 8,435 headache
8 486 7,819 pneumonia, organism nos
9 7999 7,268 viral infection nos
10 78039 7,075 convulsions nec
11 78900 6,854 abdmnal pain unspcf site
12 6826 6,493 cellulitis of leg
13 78703 6,443 vomiting alone
14 49392 6,419 asthma nos w(ac) exacerb
15 4019 5,435 hypertension nos
16 7242 5,284 lumbago
17 78659 5,182 chest pain nec
18 490 5,005 bronchitis nos
19 64893 4,917 oth curr cond-antepartum
20 7295 4,913 pain in limb
21 4660 4,261 acute bronchitis
22 7804 4,242 dizziness and giddiness
23 78909 4,030 abdmnal pain oth spcf st
24 78652 3,454 painful respiration
25 6823 3,303 cellulitis of arm
36
Table 5. Most frequent Conditions of Patients with Non Primary Care Related ED Visits (N=25)
Obs Icd COUNT Description
1 78650 5,835 chest pain nos
2 78900 3,380 abdmnal pain unspcf site
3 78659 3,297 chest pain nec
4 7806 3,222 fever
5 7802 2,828 syncope and collapse
6 5921 2,514 calculus of ureter
7 78909 1,987 abdmnal pain oth spcf st
8 5920 1,901 calculus of kidney
9 64003 1,545 threaten abort-antepart
10 V715 1,395 observ following rape
11 78703 1,381 vomiting alone
12 7840 1,259 headache
13 4644 1,249 croup
14 7851 1,195 palpitations
15 57420 1,100 cholelithiasis nos
16 53550 995 gstr/ddnts nos w/o hmrhg
17 5770 975 acute pancreatitis
18 7880 952 renal colic
19 46619 923 acu brnchlts d/t oth org
20 5409 918 acute appendicitis nos
21 42731 863 atrial fibrillation
22 78906 840 abdmnal pain epigastric
23 28262 823 hb-s disease with crisis
24 7999 815 viral infection nos
25 78605 808 shortness of breath
37
Geographic Distribution of Patients with Primary Care-Related Visits
ED visits were mapped according to both frequency and rate. Rates were based on 2005
population and on 2005 insurance enrollment. The ZIP codes of 77010 and 77046 were excluded
from the rate maps for having populations below 2,000. Insurance rates were grouped into three
categories: a) persons who were uninsured (based on 2005 estimates), b) persons who were
enrolled in Medicaid (based on fall 2005 Medicaid enrollment), and c) non-Medicaid insured
(the remainder, primarily consisting of the privately insured and those covered by Medicare). It
was not feasible to disaggregate the non-Medicaid insured rate.
Overall ED visits, primary care related ED visits in general, primary care related ED
visits by persons who were uninsured, and primary care related ED visits by persons who were
enrolled in Medicaid were made most often by residents of the following ZIP code clusters (in
clockwise order): 1) Aldine/Fifth Ward/northeast section of the 610 loop (both inside and outside
the loop); 2) the Ship Channel; 3) Galena Park and parts of Pasadena; 4) Third Ward and South
Park/central and southern part of the 610 loop; 5) southwestern/Alief/Sharpstown area; 6) Bear
Creek/intersection of interstate 10 and highway 6; and 7) Acres Homes/Spring Branch (Maps 1,
2, 3, and 4).
Primary care related ED visits by the non-Medicaid insured came from many of the same
areas, but also from suburban areas such as Katy, Pearland, Friendswood, and The Woodlands
(Map 5).
When examined in terms of population rates, the areas with the highest rates of overall
ED visits, primary care related ED visits in general, and primary care related ED visits by the
uninsured are the east/northeast and south central areas of Harris County (Maps 6, 7, and 8).
38
When examined in terms of insurance rates, the east/northeast section of Harris County –
particularly along the Ship Channel – continued to show the highest rate of primary care related
ED visits, regardless of payer source (Maps 9, 10, and 11). South central Harris County had a
high rate of primary care related ED visits both for persons who were uninsured and for persons
who were non-Medicaid insured (Maps 9 and 11). The Woodlands area showed a high rate of
primary care related ED visits for persons on Medicaid (Map 10), and the Katy area showed a
high rate of primary care related ED visits for anyone with some form of insurance coverage
(Maps 10 and 11).
39
Map
1
40
Map
2
41
Map
3
42
Map
4
43
Map
5
44
Map
6
45
Map
7
46
Map
8
47
Map
9
48
Map
10
49
Map
11
50
2002-2005 Comparison
ED visits in eleven hospitals (Ben Taub General, LBJ General, Memorial Hermann Texas
Medical Center, Memorial Hermann Southwest, Memorial Hermann Southeast, Memorial
Hermann Northwest, Memorial Hermann The Woodlands, Memorial Hermann Memorial City,
Memorial Hermann Katy, Memorial Hermann Sugar Land, and St. Joseph Medical Center)
increased from 465,909 in 2002 to 485,882 in 2003, and decreased by 2005 to 381,339 (Table 6).
The percentage of total visits that were primary care related rose from 52.1% in 2002 to 54.2% in
2005 of total visits and from 81.5% in 2002 to 83.1% of categorized visits in 2005. Among
classified visits, there was a slight increase in non emergent cases from 2002 to 2004, followed
by a slight drop in 2005.
Commercial or private insurance has continued to decline as a payer source of
primary care related ED visits, with Medicaid holding fairly steady for the last three
years. The uninsured continue to figure predominantly in the payer mix (Figure 13).
There has been an increase in the number of primary care related ED visits
by Hispanics and a decrease in the number by Whites. There has been some fluctuation
among Blacks but Blacks continue to have the greatest proportion of primary care
related ED visits (Figure 14).
Except for a slight increase among those age 18-64 in 2004, there has been almost
no variation by age from 2002 to 2005 (Figure 15). There has been no change in the
gender ratio (Figure 16).
Even though Memorial Hermann Northeast is now part of the Memorial Hermann
system, it is not included in the analyses of these eleven.
51
Table 6. 2002-2005 ED Visits at Eleven Hospitals by Harris County Residents
Type of Visit 2002 2003 2004 2005
Number 11 11 11 11
CATEGORIZED VISITS
Non-Emergent 103,205 110,722 118,218 93,265
Emergent, Primary Care Treatable 103,377 109,885 108,342 87,744
Emergent, ED Care Needed - Preventable/Avoidable 36,371 38,340 32,729 25,737
Total Primary Care Related Visits 242,953 258,947 259,289 206,745
Emergent, ED Care Needed - NOT Preventable/Avoidable 55,293 57,130 51,139 42,016
Total Categorized Visits 298,246 316,077 310,428 248,761
NON-CATEGORIZED ED VISITS
Injury 107,025 109,032 107,690 85,301
Mental Health Related 7,660 7,901 8,999 7,278
Alcohol or Drug Related 4,107 3,854 3,995 3,202
Unclassified 48,871 49,018 42,153 36,797
Total Non-Categorized Visits 167,663 169,805 162,838 132,578
Total Visits 465,909 485,882 473,266 381,339
Percent
DETAIL - CATEGORIZED ED VISITS
Non-Emergent 34.6% 35.0% 38.1% 37.5%
Emergent - Primary Care Treatable 34.7% 34.8% 34.9% 35.3%
ED Care Needed - Prev./Avoid. 12.2% 12.1% 10.5% 10.3%
% Primary Care Related Visits 81.5% 81.9% 83.5% 83.1%
ED Care Needed - NOT Prev./Avoid. 18.5% 18.1% 16.5% 16.9%
TOTAL ED VISITS
Non-Emergent 22.2% 22.8% 25.0% 24.5%
Emergent - Primary Care Treatable 22.2% 22.6% 22.9% 23.0%
ED Care Needed - Prev./Avoid. 7.8% 7.9% 6.9% 6.7%
% Primary Care Related Visits 52.1% 53.3% 54.8% 54.2%
ED Care Needed - NOT Prev./Avoid. 11.9% 11.8% 10.8% 11.0%
% Categorized ED Visits 64.0% 65.1% 65.6% 65.2%
Injury 23.0% 22.4% 22.8% 22.4%
Mental Health Related 1.6% 1.6% 1.9% 1.9%
Alcohol or Drug Related 0.9% 0.8% 0.8% 0.8%
Unclassified 10.5% 10.1% 8.9% 9.6%
% All Visits 100.0% 100.0% 100.0% 100.0%
52
Figure 13. 2002-2005 Primary Care Related ED Visits by Payer Source
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
Com
merc
.
Med
icaid
Med
icar
e
Oth
er G
ov.
Oth
er P
riv.
Unin
sure
d
2002
2003
2004
2005
Figure 14. 2002-2005 Primary Care Related ED Visits by Race/Ethnicity
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Asian
Black
Hispa
nic
Am
. Indi
an
Oth
er
Unkn
own
White
2002
2003
2004
2005
53
Figure 15. 2002-2005 Primary Care Related ED Visits by Age
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
2002 2003 2004 2005
0-17
18-64
65+
Figure 16. 2002-2005 Primary Care Related ED Visits by Gender
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
2002 2003 2004 2005
Female
Male
