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{ "pk": 10628, "title": "Emergency Department Use across 88 Small Areas after Affordable Care Act Implementation in Illinois", "subtitle": null, "abstract": "Introduction:\n This study analyzes changes in hospital emergency department (ED) visit ratesbefore and after the 2014 Affordable Care Act (ACA) insurance expansions in Illinois. We comparethe association between population insurance status change and ED visit rate change between a24-month (2012-2013) pre-ACA period and a 24-month post-ACA (2014-2015) period across 88socioeconomically diverse areas of Illinois.\nMethods:\n We used annual American Community Survey estimates for 2012-2015 to obtain insurancestatus changes for uninsured, private, Medicaid, and Medicare (disability) populations of 88 IllinoisPublic Use Micro Areas (PUMAs), areas with a mean of about 90,000 age 18-64 residents. Over 12million ED visits to 201 non-federal Illinois hospitals were used to calculate visit rates by residents ofeach PUMA, using population-based mapping weights to allocate visits from zip codes to PUMAs. Wethen estimated n=88 correlations between population insurance-status changes and changes in EDvisit rates per 1,000 residents comparing the two years before and after ACA implementation.\nResults:\n The baseline PUMA uninsurance rate ranged from 6.7% to 41.1% and there was 4.6-fold variation in baseline PUMA ED visit rates. The top quartile of PUMAs had >21,000 reductionsin uninsured residents; 16 PUMAs had at least a 15,000 person increase in Medicaid enrollment.Compared to 2012-2013, 2014-2015 average monthly ED visits by the uninsured dropped 42%,but increased 42% for Medicaid and 10% for the privately insured. Areas with the largest increasesin Medicaid enrollment experienced the largest growth in ED use; change in Medicaid enrollmentwas the only significant correlate of area change in total ED visits and explained a third of variationacross the 88 PUMAs.\nConclusion:\n ACA implementation in Illinois accelerated existing trends towards greater use of hospitalED care. It remains to be seen whether providing better access to primary and preventive care tothe formerly uninsured will reduce ED use over time, or whether ACA insurance expansion is a partof continued, long-term growth. Monitoring ED use at the local level is critical to the success of newhome- and community-based care coordination initiatives. [West J Emerg Med. 2017;18(5)811-820.]", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Affordable Care Act, Emergency Medicine, Small Area Analysis, Health Insurance" } ], "section": "Societal Impact on Emergency Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2hh5j68s", "frozenauthors": [ { "first_name": "Joe", "middle_name": "", "last_name": "Feinglass", "name_suffix": "", "institution": "Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, Illinois", "department": "None" }, { "first_name": "Andrew", "middle_name": "J.", "last_name": "Cooper", "name_suffix": "", "institution": "Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, Illinois", "department": "None" }, { "first_name": "Kelsey", "middle_name": "", "last_name": "Rydland", "name_suffix": "", "institution": "Northwestern University, Northwestern University Library, Evanston, Illinois", "department": "None" }, { "first_name": "Emile", "middle_name": "S.", "last_name": "Powel", "name_suffix": "", "institution": "Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Megan", "middle_name": "", "last_name": "McHugh", "name_suffix": "", "institution": "Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois\nNorthwestern University Feinberg School of Medicine, Center for Healthcare Studies, Chicago, Illinois", "department": "None" }, { "first_name": "Raymond", "middle_name": "", "last_name": "Kang", "name_suffix": "", "institution": "Northwestern University Feinberg School of Medicine, Center for Healthcare Studies, Chicago, Illinois", "department": "None" }, { "first_name": "Scott", "middle_name": "M.", "last_name": "Dresden", "name_suffix": "", "institution": "Northwestern University Feinberg School of Medicine, Division of General Internal Medicine and Geriatrics, Chicago, Illinois", "department": "None" } ], "date_submitted": "2017-02-19T21:33:11Z", "date_accepted": "2017-02-19T21:33:11Z", "date_published": "2017-07-17T15:19:41Z", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10628/galley/5826/download/" } ] }