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{
    "pk": 14096,
    "title": "Underutilization of the Emergency Department During the COVID-19 Pandemic",
    "subtitle": null,
    "abstract": "Introduction: \nThe novel coronavirus 2019 (COVID-19) pandemic in the United States (US) prompted widespread containment measures such as shelter-in-place (SIP) orders. The goal of our study was to determine whether there was a significant change in overall volume and proportion of emergency department (ED) encounters since SIP measures began.\nMethods:\n This was a retrospective, observational, cross-sectional study using billing data from January 1, 2017–April 20, 2020. We received data from 141 EDs across 16 states, encompassing a convenience sample of 26,223,438 ED encounters. We used a generalized least squares regression approach to ascertain changes for overall ED encounters, hospital admissions, and New York University ED visit algorithm categories.\nResults: \nED encounters decreased significantly in the post-SIP period. Overall, there was a 39.6% decrease in ED encounters compared to expected volume in the pre-SIP period. Emergent encounters decreased by 35.8%, while non-emergent encounters decreased by 52.1%. Psychiatric encounters decreased by 30.2%. Encounters related to drugs and alcohol decreased the least, by 9.3% and 27.5%, respectively.\nConclusion: \nThere was a significant overall reduction in ED utilization in the post-SIP period. There was a greater reduction in lower acuity encounters than higher acuity encounters. Of all subtypes of ED encounters, substance abuse- and alcohol-related encounters reduced the least, and injury-related encounters reduced the most.",
    "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": "COVID-19"
        }
    ],
    "section": "Endemic Infections",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/00p3c3fm",
    "frozenauthors": [
        {
            "first_name": "Anthony",
            "middle_name": "David",
            "last_name": "Lucero",
            "name_suffix": "",
            "institution": "Kaweah Delta Medical Center",
            "department": "None"
        },
        {
            "first_name": "Andre",
            "middle_name": "",
            "last_name": "Lee",
            "name_suffix": "",
            "institution": "Kaweah Delta Medical Center, Department of Emergency Medicine, Visalia, California",
            "department": "None"
        },
        {
            "first_name": "Jenny",
            "middle_name": "",
            "last_name": "Hyun",
            "name_suffix": "",
            "institution": "Vituity, Department of Enterprise Data Analytics, Emeryville, California",
            "department": "None"
        },
        {
            "first_name": "Carol",
            "middle_name": "",
            "last_name": "Lee",
            "name_suffix": "",
            "institution": "Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California",
            "department": "None"
        },
        {
            "first_name": "Chadi",
            "middle_name": "",
            "last_name": "Kahwaji",
            "name_suffix": "",
            "institution": "Kaweah Delta Medical Center, Department of Emergency Medicine, Visalia, California",
            "department": "None"
        },
        {
            "first_name": "Gregg",
            "middle_name": "",
            "last_name": "Miller",
            "name_suffix": "",
            "institution": "Swedish Edmonds Campus, Department of Emergency Medicine, Edmonds, Washington",
            "department": "None"
        },
        {
            "first_name": "Michael",
            "middle_name": "",
            "last_name": "Neeki",
            "name_suffix": "",
            "institution": "Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California",
            "department": "None"
        },
        {
            "first_name": "Joshua",
            "middle_name": "",
            "last_name": "Tamayo-Sarver",
            "name_suffix": "",
            "institution": "Good Samaritan Hospital, Department of Emergency Medicine, San Jose, California",
            "department": "None"
        },
        {
            "first_name": "Luhong",
            "middle_name": "",
            "last_name": "Pan",
            "name_suffix": "",
            "institution": "Vituity, Department of Enterprise Data Analytics, Emeryville, California",
            "department": "None"
        }
    ],
    "date_submitted": "2020-06-10T03:42:44+10:00",
    "date_accepted": "2020-06-10T03:42:44+10:00",
    "date_published": "2020-11-04T19:00:00+11:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/14096/galley/7305/download/"
        }
    ]
}