Chronic Care on the Rise in California EDs

The amount of care provided in California emergency departments (EDs) for non-injuries, like complex, chronic conditions has increased, according to a study led by the University of California, San Francisco (UCSF) and published in Health Affairs.

From 2005 to 2011 the ED visit rate for injuries fell 0.7% while the rate of visits for non-injuries increased by 13.4%. The authors identified a rise in symptom-related diagnoses such as abdominal pain, along with nervous system disorders, gastrointestinal disease, and mental illness.

“While many people think of the ED as simply a place to go when you have a car accident or some type of major trauma, it is increasingly the case that the emergency department is caring for complex medical patients,” lead author Renee Y. Hsia, MD, professor of emergency medicine at UCSF and director of health policy studies in the UCSF Department of Emergency Medicine, said in a statement.

Based on their analysis, the authors determined that patients admitted through the ED from 2005 to 2011 had an increasing number of comorbidities, which indicates they are increasingly medically complex and seriously ill.

“The overall trend away from ED care for injuries mirrors recent changes in the US disease burden. The mortality rate from injuries remained relatively stable from 2005 to 2011, and the number of adults with multiple chronic diseases has risen,” the authors wrote.

Overall, the researchers found few notable insurance-specific trends. For instance, while the rate of ED use for mental illness grew faster than any other diagnosis group among patients who were uninsured, the rate of growth in mental health conditions as a primary diagnosis was significant among the uninsured, Medicare beneficiaries, and the privately insured.

“These findings suggest that human and capital resources may need to shift in ways that more accurately reflect the demands placed on EDs,” the authors wrote. “For example, the large growth in mental health conditions presenting to the ED could require an increased presence of mental health professionals and services in the ED.”