Emergency Room Use Among Adults Aged 18–64: Early Release of Estimates From the National Health Interview Survey, January–June 2011

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1 5/2012 Released : Early Emergency Room Use Among Adults Aged 18 –64 Release of Estimates lth Interview National Hea the From Survey, January –June 2011 ; and Whitney .P.H., , M Kirzinger K. ; Robin A. Cohen, Ph.D. by Renee M. Gindi, Ph.D. s Division of Health Interview Statistics, National Center for Health Statistic Introduction Highlights R ising health June 2011, care costs make it important to understand the reasons that through From January - rather than less expensive outpatient or office people seek emergency room care 64 whose last among adults aged 18– hospital visit in the past 12 months did (1) based care . Surveys in 2007 and 2010 showed that about 20% of U.S. adults : common most usage with not result in hospital admission t 12 m used the emergency room in the pas had onths, for metropolitan and living outside a with public health insurance those statistical reasons for emergency room use were area (MSA) (2,3). Questions on 79.7% of adults visited the About • added to the 2011 National Health Interview Survey (NHIS). NHIS data lack of emergency room due to 19.5% of adults aged 18– show collected January – June 2011 that 64 visited an access to other providers, were admitted at their emergency room in the past 12 months, 26.7% of whom significantly more than the 66.0% last visit. who visited due to seriousness of . the medical problem vid This report pro es preliminary estimates of reasons for emergency room use S adults aged 18 whose last visit in the past 12 months did not among U. –64 The most common reasons for the • result in a hospital admission , by health insurance status, area of residence last emergency room visit were: (within or outside an MSA), and other selected variables. This report is produced only a hospital could help by the NHIS Early Release Program, which releases updated selected estimates (54.5%), the doctor's office was : http://www.cdc.gov/nchs/nhis.htm from the NHIS website available ; see not open (48.0%), or there was no nal Early Release Program Products .” Additio ” and “ Technical Notes “ . other place to go (46.3%) visit, s for last emergency room reason selected who had 1. Percentage Figure with Adults public health plan • among adults aged 18 –64 whose last visit in past 12 months did not result in were twice as likely coverage as hospital admission: United States, January –June 2011 those with no health insurance to visit the emergency room because their doctor’s office was not open . Seriousness of 66.0 Uninsured adults were more likely • medical problem with private health those than 54.5 Only hospital could help Problem too serious for insurance health plan or a public 42.5 doctor's o ffice to visit the emergency room due to 20.1 Health provider said to go having no other place to go. 8.9 Arrived by ambulance Lack of access to 79.7 living outside a Adults • other providers 48.0 metropolitan statistical area Doctor's o ffice not open (MSA) were more likely than 46.3 No other place to go those living in an MSA to visit the Emergency room is 45.8 closest provider emergency room because their Most care is at emergency room 17.7 doctor’s office was not open. 0 70 60 50 40 30 20 10 80 90 Adults with unmet medical need • Percent were less likely than adults without unmet need to visit the emergency room because their E NOTES: stimates for 2011 are based on data collected from January through June. Data are based doctor’s office was not open , and on household interviews of a sample of the civilian noninstitutionalized population. “Seriousness of medical problem” and “Lack of access to other providers” are summaries based on positive responses more likely to visit because they to any of the related detailed reasons below each of the two main categories. Respondents could had no other place to go. select more than one reason. SOURCE: CDC/NCHS, National Health Interview Survey. Sample Adult omponent. Supplemental c Emergency Room Use Among Adults: Early Release of Estimates From the National Health Interview Survey 1

2 Released 5/2012 in the past 12 months did not result in visit hospital se last who –64 mong adults aged 18 June 2011, a through January From hospital admission : visited the emergency room for reasons reflecting lack of access to other providers, An estimated 79.7% of adults • ). 6.0 significantly more than the 6 seriousness of the medical problem (Figure 1 visited because of who % of adults , the last • (54.5%) The most common individual reasons for the emergency room visit were: only a hospital could help (48.0%) not open was doctor’s office in this . These reasons are explored further (46.3%) no other place to go , or there was report. s for last emergency room reason selected –64 whose last visit in past 2. Percentage ure Fig visit, among adults aged 18 who had , by insurance coverage status 12 months did not result in hospital admission –June , January : United States at time of interview 2011 Percent Public coverage Uninsured Private insurance 70 1,2 61.6 59.7 60 55.6 53.4 51.8 2 49.9 48 .5 50 2 38.9 40 1,2 30.9 30 20 10 0 ffice Only hospital Doctor's o No other or clinic was could help place to go not open 1 Significantly differs from private insurance, p < 0.05. 2 . p < 0.05 Significantly differs from public coverage, Estimates for 2011 are based on data collected from January through June. Data are based on household interviews of a sample of the civilian NOTES: noninstitutionalized population. National Health Interview Survey, SOURCE: CDC/NCHS, . Family Core and Sample Adult Supplemental components During –June 2011, a mong adults who se January emergency room visit in the past 12 months did not result in hospital last admission : • Uninsured adults were more likely to visit the emergency room because they had no other place to go at the time of the last visit (61.6%), compared with adults having private insurance (38.9%) or those with public health plan coverage (48.5%) (Figure 2). Uninsured adults were significantly less likely to visit the emergency room because the doctor’s office was not open at the • ts with private insurance (49.9% time of their last visit (30.9%) than adul ) or those with publ ic health plan coverage (59.7%) . Among adults who also had a usual place of care, those who were uninsured were significantly less likely to visit the emergency room because the doctor’s office was not open at the time of their last visit (42.3%) than adults with private insurance (51.4%) or adults with public health plan coverage (62.9 %) (data not shown) . Approximately one -half of uninsured, privately insured, and public health plan -covered adults visited the emergency room • . only a hospital could help them at the last visit, because, Emergency Room Use Among Adults: Early Release of Estimates From the National Health Interview Survey 2

3 Released 5/2012 who had Fig ure selected 3. Percentage s for last emergency room visit, among adults aged 18 –64 whose last visit in past reason 12 months did not result in hospital admission , by residence –June 2011 , January : United States in a metropolitan statistical area Percent Within MSA Outside MS A 70 58.1 60 55.7 51.7 49.5 50 1 45 .6 45 .0 40 30 20 10 0 Doctor's o ffice Only hospital No other or clinic was could help place to go not open 1 < 0.05. p Significantly differs from outside MSA, f the civilian Estimates for 2011 are based on data collected from January through June. Data are based on household interviews of a sample o NOTES: MSA is metropolitan statistical area. noninstitutionalized population. SOURCE: CDC/NCHS, National Core and Sample Adult Supplemental components , Family Health Interview Survey . From June 2011, among adults aged 18 –64 whose through last emergency room visit in the past 12 months did not January result in hospital admission: 45.0% of adults who lived in an MSA and 51.7% of those who lived outside an MSA visited the emergency room About • because, at the last visit, they had no other place to go (Figure 3). • Adults who lived outside an MSA (58.1%) were more likely than adults living in an MSA (45.6%) to v isit the emergency room because their doctor’s office was not open at the time of the last visit. Among adults who also ha d a usual place of (63.6%) were significantly more likely than adults living in an MSA (50.7%) to care, those who lived outside an MSA visit . (data not shown) the emergency room because their doctor’s office was not open at the time of the last visit outside an MSA visited the emergency room one adults living within an MSA and Approximately those • living -half of both . only a hospital could help them visit, at the last because, 3 Early Release of Estimates From the National Health Interview Survey Emergency Room Use Among Adults:

4 Released 5/2012 –64 whose last emergency room visit in the s for last visit, among adults aged 18 reason selected who had Fig ure 4. Percentage , January –June 2011 past 12 months did not result in hospital admission , by unmet medical need : United States Percent No unmet medical need Unmet medical need 70 1 60 57.3 56.3 54.2 50.6 49.5 50 45 .0 43 .0 1 39.8 40 30 20 10 0 Only hospital Doctor's o ffice No other or clinic was could help place to go not open 1 Significantly differs from no unmet medical need, p < 0.05. NOTES: E f the stimates for 2011 are based on data collected from January through June. Data are based on household interviews of a sample o noninstitutionalized population. civilian Core and Sample Adult Supplemental components , Family SOURCE: CDC/NCHS, National Health Interview Survey . last January –June 2011, among adults aged 18 –64 whose During emergency room visit in the past 12 months did no t result in hospital admission: An estimated 57.3% of adults with unmet medical need visited the emergency room because they had no other place to go, • significantly more than the 43.0% of adults without unmet medical need. Adults with unmet medical need were less likely • to visit the emergency room because their doctor’s office was not open than adults without unmet medical need (39.8%) had a usual place of care, those However, among adults who also (50.6%). l need were just as likely to visit the emergency room because their doctor’s office was not open (52.6%) with unmet medica as adults wit hout unmet medical need (53.5%) (data not shown) . • Slightly more than one -half of adults visited the emergency room because only the hosp ital could help, regardless of unmet medical need. 4 Early Release of Estimates From the National Health Interview Survey Emergency Room Use Among Adults:

5 (Released 5/2012) who had selected reason Percentage Table 1. s for last visit, among adults aged –64 whose last emergency room visit in the past 12 months did not result in 18 , by selected characteristics: United States, January hospital admission –June 2011 1 Selected reason for last emergency room visit Doctor’s office or clinic Selected characteristic No other place to go Only a hospital could help was not open Percent (standard error) 46.3 (1.46) 48.0 (1.46) Total 54.5 (1.41) Sex 44.6 (2.45) 57.8 (2.17) Male 46.0 (2.26) 46.5 (1.74) 50.4 (1.77) 52.1 (1.84) Female Age – 18 45.7 (3.43) 24 46.9 (3.58) 48.1 (3.21) years 25 – 34 years 48.8 (2.86) 46.0 (3.14) 57.2 (2.95) 35 – years 48.6 (2.87) 52.6 (2.87) 53.5 (3.09) 44 – 47.1 (2.37) years 43.6 (2.19) 45 57.1 (2.07) 64 ethnicity Race/ Hispanic 44.3 (3.43) 59.2 (3.50) 50.6 (3.17) Non - Hispanic white only 44.9 (1.91) 48.8 (2.09) 54.1 (1.87) Non - 43.6 (2.91) 43.8 (2.64) 51.0 (3.19) Hispanic black only - Hispanic Asian only 40.1 (6.66) 53.5 (8.11) 51.8 (6.99) Non Non - Hispanic other races 66.3 (5.84) 64.4 (6.47) 60.5 (6.51) 2 Residence In 45.0 (1.60) 45.6 (1.63) 55.7 (1.58) MSA 49.5 (3.21) 58.1 (3.22) 51.7 (3.80) Not in MSA 3 Poverty status 55.4 (3.00) 48.6 (3.07) 49.7 (2.84) Poor 50.7 (2.80) 49.4 (2.97) 59.3 (2.67) Near poor 48.3 (2.18) 54.0 (2.09) 41.0 (1.96) Not poor Insurance coverage status at time of interview 4 61.6 (3.34) Uninsured 30.9 (2.85) 51.8 (3.16) 5 Private 38.9 (1.92) 49.9 (1.97) 55.6 (2.11) 6 48.5 (2.75) 59.7 (2.58) 53.4 (2.36) Public 7 Health s tatus Excellent Very good 43.4 (1.88) 44.9 (2.00) 54.8 (1.87) / Good 45.3 (2.77) 48.9 (2.78) 53.6 (2.73) 54.6 (2.80) 55.0 (2.87) Fair/ Poor 55.1 (3.30) 8 Usual place of care 41.5 (1.67) 55.7 (1.51) 53.2 (1.61) Yes 65.9 (3.02) 26.1 (3.14) 49.3 (3.43) No 9 Unmet medical need Yes 57.3 (3.05) 39.8 (2.85) 56.3 (2.93) No 43.0 (1.65) 50.6 (1.68) 54.2 (1.58) Frequency of emergency room 10 use One visit 42.7 (1.77) 45.1 (1.72) 54.3 (1.67) Two or more visits 53.0 (2.58) 53.4 (2.41) 54.9 (2.45) 1 Based on positive responses to questions in the Sample Adult component : “Tell me which of these apply to y our last emergency room visit? You didn’t have another place to go. Your doctor’s office or clinic was not open. Only a hospital could help you .” These questions were asked only of those with a positive response to the question, “ DURING THE PAST 12 MONTHS, HOW MANY TIMES have you gone t o a HOSPITAL EMERGENCY ROOM about your own health (This includes emergency room visits that resulted in a hospital admission.)? ” and a negative response to the question, “Did this emergency room visit result in a hospital admission?” 2 etropolitan statistical area (MSA), as defined by the Office of Management and Budget . Within or outside a m 3 Based on family income and family size, using the U.S. Census Bureau’s poverty thresholds. “Poor” persons are defined as thos e below the poverty threshold; overty threshold or persons have incomes of 100% to less than 200% of the poverty threshold; and “not poor” persons have incomes of 200% of the p “near poor” . Estimates for persons with unknown poverty status greater. The percentage of respondents with unknown poverty status was 11.6% in the first two quarters of 2011 Emergency Room Use Among Adults: Early Release of Estimates From the National Health Interview Survey 5

6 (Released 5/2012) are included in the total but are not shown separately. For more information on the unknown income and poverty status categor ies, see “ NHIS Survey Description ” for 2010, available from: http://www.cdc.gov/nchs/nhis.htm . Estimates may differ from estimates based on both reported and imputed income. 4 - Defined as not hav ing any private health insurance, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), state- sponsored or other government overage or had only a private plan that sponsored health plan, or military plan. A person was also defined as uninsured if he or she had only Indian Health Service c paid for one type of service, such as accidents or dental care. 5 Excludes plans that paid for only one type of service, such as accidents or dental care. A small number of persons were cover ed by both public and pri vate plans and were included in both categories. 6 Includes Medicaid, Children’s Health Insurance Program (CHIP), state -sponsored or other government -sponsored health plan, Medicare (disability), and military plans. A small number of persons were covered by both public and private plans and were included in both categories. 7 “Would you say your health in general was excellent, very good, good, fair, or poor?” Obtained from a question in the Family Core component that asked, 8 Core component e Adult a question in the Sampl Based on “Is there a place that you USUALLY go to when you are sick or need advice about your that asked, -up question was asked: “What kind of place [is it/do you go to most often] —a clinic, doctor’s office, health?” If there was at least one such place, then a follow Choices for the second question were: “clinic or health center,” “doctor’s office or HMO,” “hospital emergency room,” emergency room, or some other place?” “doesn’t go to o “hospital outpatient department,” “some other place,” or ne place most often.” Adults who indicated that the emergency room was their usual place for care were considered not to have a usual place of health care. 9 : “DURING THE PAST 12 MONTHS , [have you delayed Based on a positive response to either of the following two questions in the Family Core component and “ DURING THE PAST 12 MONTHS seeking medical care/has medical care been delayed for anyone in the family] because of worry about the cost?” , was there any time when [you/someone in the family] needed medical care, but did not get it because [you/the family] couldn’t afford it?” Dental care is excluded. 10 in the Sample Adult Core component that asked Based on a question , “During the past 12 months, how many times have you gone to a hospital emergency room abou t your own health (This includes emergency room visits that resulted in a hospital admission.)?” stimates for 2011 are based on data collected from January through June. Data are based on household interviews of a sample o f the civilian NOTES: E tionalized population. noninstitu al component SOURCE: CDC/NCHS, National Health Interview Survey, Family Core and Sample Adult Core s, 2011 . and Supplement Emergency Room Use Among Adults: Early Release of Estimates From the National Health Interview Survey 6

7 (Released 5/2012) reason s for last visit, among adults aged 18– Table 2. Percentage who had summary 64 whose last emergency room visit in the past 12 months did not result in hospital , by selected characteristics: United States, January –June 2011 admission oom visit Summary reason for last emergency r Lack of access to other Seriousness of medical Selected characteristic 1 2 providers problem Percent (standard error) Total 66.0 (1.39) 79.7 (1.16) Sex Male 68.0 (2.08) 80.9 (1.95) Female 64.5 (1.77) 78.9 (1.46) Age 18 – 24 years 60.3 (3.01) 85.2 (2.50) 77.9 (2.44) 25 – 34 years 65.7 (2.88) 35 44 years 65.1 (3.03) 76.9 (2.63) – 45 – 64 years 70.0 (1.93) 79.4 (2.02) Race/ ethnicity Hispanic 67.9 (3.41) 80.8 (2.97) Non - Hispanic white only 65.8 (1.80) 77.9 (1.55) Non - 63.7 (2.95) 83.2 (2.39) Hispanic black only Non Hispanic Asian only 70.5 (5.79) 77.9 (6.84) - Non - Hispanic other races 69.7 (5.79) 92.0 (3.10) 3 Residence In 67.2 (1.54) 78.9 (1.34) MSA 83.2 (2.29) 61.1 (3.17) Not in MSA 4 Poverty status Poor 85.5 (1.85) 61.8 (2.68) 69.9 (2.57) 82.6 (2.56) Near poor 65.3 (2.12) 76.3 (1.73) Not poor Insurance coverage status at time of interview 5 Uninsured 82.3 (2.50) 61.5 (3.08) 6 76.6 (1.67) 66.7 (2.15) Private 7 Public 67.4 (2.18) 84.4 (1.85) 8 tatus Health s Excellent / Very good 65.3 (1.88) 77.6 (1.53) Good 65.7 (2.56) 80.5 (2.45) Fair/ Poor 68.1 (2.69) 84.0 (2.06) 9 Usual place of care 78.2 (1.35) 67.1 (1.51) Yes No 86.1 (2.33) 61.2 (3.30) 10 Unmet medical need 67.6 (2.69) Yes 79.7 (2.85) No 65.8 (1.59) 79.7 (1.23) Frequency of emergency room 11 use 77.0 (1.50) One visit 64.6 (1.67) Two or more visits 68.6 (2.21) 84.9 (1.86) 1 Based on a positive response to any one of these questions in the Sample Adult component : “Tell me which of these apply to your last emergency room visit? Your health provider advised you to go. The problem was too serious for the doctor’s office or clinic. Only a hospital could help you. You arrived by ambulance or other emergency vehicle.” Respondents could select more than one reason. 2 : “Tell me which of these apply to your last emergency room visit? Based on a p to any one of the se questions in the Sample Adult component ositive response You didn’t have another place to go. Your doctor’s office or clinic was not open. The emergency room is your clos est provider. You get most of your care at the emergency room.” Respondents could select more than one reason. 3 area (MSA), as defined by the Office of Management and Budget . statistical etropolitan Within or outside a m 4 ize, using the U.S. Census Bureau’s poverty thresholds. “Poor” persons are defined as those below the poverty threshold; Based on family income and family s poverty threshold or 00% of the “near poor” persons have incomes of 100% to less than 200% of the poverty threshold; and “not poor” persons have incomes of 2 Estimates for persons with unknown poverty status greater. The percentage of respondents with unknown poverty status was 11.6% in the first two quarters of 2011. Emergency Room Use Among Adults: Early Release of Estimates From the National Health Interview Survey 7

8 (Released 5/2012) tion on the unknown income and poverty status categories, see “ NHIS Survey Description are included in the total but are not shown separately. For more informa ” for 2010, available from: http://www.cdc.gov/nchs/nhis.htm . Estimates may differ from estimates based on both reported and imputed income. 5 sponsored or other government any private health insurance, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), state- Defined as not hav - ing sponsored health plan , or military plan. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care. 6 Excludes plans that paid for only one type of service, such as accidents or dental care. A small number of persons were covered by both public and private plans and were included in both categories. 7 nsored health plan, Medicare (disability), and military -sponsored or other government -spo Includes Medicaid, Children’s Health Insurance Program (CHIP), state plans. A small number of persons were covered by both public and private plans and were included in both categories. 8 Obtained from a question in the Family Core component our health in general was excellent, very good, good, fair, or poor?” : “Would you say y that asked 9 “Is there a place that you USUALLY go to when you are sick or need advice about your Based on a question in the Sample Adult Core component that asked, health?” If there was at least o —a clinic, doctor’s office, s it/do you go to most often] ne such place, then a follow -up question was asked: “What kind of place [i Choices for the second question were: “clinic or health center,” “doctor’s office or HM O,” “hospital emergency room,” emergency room, or some other place?” emergency room was their usual place “hospital outpatient department,” “some other place,” and “doesn’t go to one place most often.” Adults who indicated that the are. for care were considered not to have a usual place of health c 10 Based on a positive response to either of the following two questions in the Family Core component : “DURING THE PAST 12 MONTHS, [have you delayed seeking medical care/has medical care been delayed for anyone in the family] because of worry about the cost?” and “DURING THE PAST 12 MONTHS, was ord it?” Dental care is excluded. there any time when [you/someone in the family] needed medical care, but did not get it because [you/the family] couldn’t aff 11 Based on a question in the Sample Adult Core compon ent that asked , “During the past 12 months, how many times have you gone to a hospital emergency room about your own health (This includes emergency room visits that resulted in a hospital admission.)?” stimates for 2011 are based on data collected from January through June. Data are based on household interviews of a sample o f the civilian NOTES: E noninstitutionalized population. . , 2011 SOURCE: CDC/NCHS, National Health Interview Survey, Family Core and Sample Adult Core and Supplemental components Emergency Room Use Among Adults: Early Release of Estimates From the National Health Interview Survey 8

9 (Released 5/2012) Technical Notes The National Health Interview Survey (NHIS) is the principal source of health information for the civilian noninstitutionalized population of the U nited States and is conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) for adults . NCHS is releasing selected estimates of emergency room use aged 18 –64 in the civilian noninstitutionalized U.S. population based on data from the 2011 NHIS. The estimates are being released prior to final data editing and final weighting, to provide access to the most recent information from NHIS. The resulting estimates for persons without health i nsurance are generally 0.1 –0.3 percentage point s lower than those based on the editing procedures used for the final data files. Occasionally, because of decisions made for t he ures may differ by more than 0.3 percentage final data editing and weighting, estimates based on preliminary editing proced points from estimates based on final files. Estimates are stratified by sex, age, race/ethnicity, area of residence, poverty status, health insurance coverage status, self - reported health status, usual place of care, unmet medical need, and frequency of emergency room use in the past 12 months . Tables are shown only for adults aged 18 –64. Data source Data used to produce this Early Release report are derived from the Family Core, Sample Adult Core, and Sample Adult Supplemental components of the NHIS from January through June 2011. These components collect information on all family ore persons in the Family C members in each household . Data analyses for the January –June 2011 NHIS were based on 52,043 . Visit the NHIS website at al components and Supplement Adult Core and 17,040 adults in the Sample http://www.cdc.gov/nchs/nhis.htm ign, content, and use of NHIS. for more information about the des Estimation procedures NCHS creates survey weights for each calendar quarter of the NHIS sample. The NHIS data weighting procedure is described in more detail at: http://www.cdc.gov/nchs/data/series/sr_02/sr02_130.pdf . Estimates were calculated using the NHIS survey weights, which are calibrated to census totals for sex, age, and race/ethnicity of the U.S. civilian noninstitutionalized population. Weights for the 2011 NHIS data were derived from 2000 census -based population estimates. Point estimates, and estimates of their variances, were calculated using SUDAAN software to account for the complex sample design of NHIS. The Taylor series linearization method was chosen for variance estimation. Unless otherwise noted, all estimates shown meet the NCHS standard of relative standard error less than or equal to 30%. Differences between percentages or rates were evaluated using two -sided significance tests at the 0.05 level. Terms such as ,” and “compared with” indicate a statistically significant difference. Terms such as “similar” and “no “greater than ,” “less than difference” indicate t hat the estimates being compared were not significantly different. Lack of comment regarding the difference between any two estimates does not necessarily mean that the difference was tested and found to be not significant . Definitions of selected terms Emergency room visit — Based on a positive response to the question in the Sample Adult Core component that asked, “During the past 12 months, how many times have you gone to a hospital emergency room about your own health (This includes emergency room visits that resulted in a hospital admission.)?” Reasons for last emergency room visit — Respondents who indica ted that they had visited the emergency room one or “During the past more times in the ing the question in the Sample Adult Core component that asked, past 12 months in answer 12 months, how many times have you gone to a hospital emerg ency room about your o wn health (This includes emergency room visits that resulted in a hospital admission.)?” were then asked , “Did this emergency room visit result in a hospital admission?” Those who indicated that the emergency room visit did not result in a hospital admission were asked additional that asked, questions about the reason for the visit and could respond positively to more than one reason in the question “Tell me ? You didn’t have another place to go. Your doctor’s office or clinic was which of these apply to your last emergency room visit not open. Your health provider advised you to go. The problem was too serious for the doctor’s office or clinic. Only a hospital You get most of your care at the emerg could help you. The emergency room is your closest provider. ency room. You arrived Emergency Room Use Among Adults: Early Release of Estimates From the National Health Interview Survey 9

10 (Released 5/2012) ” Of the eight reasons asked about , the three most common ( by ambulance or other emergency vehicle. only a hospital could help, doctor’s office or clinic was not open, and no other place to go) are explored in further detail in this r eport. — Respondents who indicated that they had visited the emergency room Hospital admission at last emergency room visit one or more times in the past 12 months in answer ing the question in the Sample Adult Core component that asked, “During the past 12 months, how many times have you gone to a hospital emergency room about your own health (This includes emergency room visits that resulted in a hospital admission.)?” were then asked , “Did this emergency room visit result in a hospital –June 2011, 26.7% of adults aged 18– January 64 who visited an admission?” According to NHIS data collected during emergency room in the past 12 months were admitted to the hospital at the last emergency room visit. This is higher than the l Hospital Ambulatory Medical Care Survey that 12.5% of all emergency room visits result in estimate from the 2007 Nationa hospital admission, using emergency room visits made by patients of all ages (4). This discrepancy may be due in part to the self -report of hospital admission by NH IS respondents, and respondents’ inability to distinguish between hospital admission and admission into an emergency department observation unit, which is not considered to be a hospital admission. Health insurance coverage at interview —H ealth insurance coverage status at interview may not be the same as coverage The status at the time of the last emergency room visit. excludes plans that pay for “Private health insurance coverage” category only one type of service such as accidents or dental care. The “ category includes Medicaid, Public health plan coverage” Children’s Health Insurance Program (CHIP), state -sponsored or other government -sponsored health plans, Medicare, and military plans. A small number of persons were covered by both public a nd private plans and were included in both categories. A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, CHIP, state- sponsored or other government -sponsored health plan, or military plan at the ti me of interview. A person was also defined as such uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service surance status (about 1% of respondents each as accidents or dental care. The analyses excluded persons with unknown health in year). two separate and distinct categories. Persons of Hispanic or Latino origin Refers to — Hispanic or Latino origin and race may be of any race. Hispanic or Latino origin includes persons of Mexican, P uerto Rican, Cuban, Central and South American, or Spanish origin. Race is based on the family respondent’s description of his or her own race background, as well as the race background of other family members. For conciseness, the text, tables, and figures in this report use shorter versions of the 1997 Office of Management and Budget terms for race and Hispanic or Latino origin. For example, the category “Not Hispanic or only” in the text, tables, and figures. -Hispanic black Latino, black or African American, single race” is ref erred to as “Non Estimates for non -Hispanic persons of races other than white only, black only, and Asian only, or of multiple races, are combined into the “ Non -Hispanic other races ” category. Poverty status — B ased on the ra tio of the family’s income in the previous calendar year to the appropriate poverty threshold (given the family’s size and number of children) defined by the U.S. Census Bureau for that year ( 5). Persons categorized as “Poor” have a ratio less than 1.0 (i. e., their family income was below the poverty threshold); “Near poor” persons have incomes of 100% to less than 200% of the poverty threshold; and “Not poor” persons have incomes that are 200% of the poverty thres hold or greater. The percentage of responde nts with unknown poverty status in the first two quarters of 2011 was for 2010 11.6% . For more information on unknown income and unknown poverty status, see “NHIS Survey Description ” (available from: http:// www.cdc.gov/nchs/nhis.htm ). income for approximately 30% of NHIS records. The imputed income files are released a few months NCHS imputes exact e, Early Release after the annual release of NHIS microdata and are not available for the Early Release reports . Therefor estimates stratified by poverty status are based on reported income only and may differ from estimates produced later that ar e based on both reported and imputed income. ased on a positive response to either of the following two questions in the Family Core Unmet medical need — B component : “DURING THE PAST 12 MONTHS, [have you delayed seeking medical care/has medical care been delayed for anyone in the family] because of worry about the cost?” and “DURING THE PAST 12 MONTHS, was there any time when [you/someone in the family] needed medical care, but did not get it because [you/the family] couldn’t afford it?” Dental care is excluded. U go to USUALLY sual place of care —B ased on responses to the survey question that asked, “Is there a place th at you -up question was asked: when you are sick or need advice about your health?” If there was at least one such place, then a follow Choices “What kind of place [is it/do you —a clinic, doctor’s office, emergency room, or some other place?” go to most often] were for the second question : “clinic or health center,” “doctor’s office or HMO,” “hospital emergency room,” “hospital Emergency Room Use Among Adults: Early Release of Estimates From the National Health Interview Survey 10

11 (Released 5/2012) emergency outpatient department,” “some other place,” or “doesn’t go to one place most often.” Adults who indicated that the room was their usual place for care were considered not to have a usual place of health care. Additional Early Release Program Products dditional reports are published through the Early Release Program. A “Early Release of Selected Estimates Based on Data From the National Health Interview Survey” is published quarterly in about March, June, September, and December and provides estimates of 15 selected measures of health, including insurance coverage. Other measures of health include estimates n, of having a usual place to go for medical care, obtaining needed medical care, influenza vaccination, pneumococcal vaccinatio -time physical activity, current smoking, alcohol consumption, HIV testing, general health status, personal care obesity, leisure needs, serious psychological distress, diagnosed diabetes, and asthma episodes and current asthma. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey ” is published quarterly “ in about March, June, September, and December and provides detailed estimates of health insurance coverage. “ Wireless Substitution: Early Release of Estimates From the National Health Interview Survey ” is published in May and provides selected estimates of telephone coverage in the United States. December and quarterly Preliminary microdata files containing selected NHIS variables are produced by the NHIS Early Release Program . For each data collection year, these files are made av ailable three times: in about September (with data from the first quarter), in about December (with data from the first two quarters), and in about March of the next year (with data from the first three access through se files the NCHS Research Data Center. quarters). Analysts may the New Early Release Program measures or products may be added as work continues and in response to changing data needs. Feedback on these releases is welcome ( [email protected] ). Announcements about Early Releases, other new data releases, publications, or corrections related to NHIS will be sent to members of the HISUSERS listserv. To join, visit the CDC website at: l . http://www.cdc.gov/subscribe.htm References Machlin S R . Expenses for a Hospital Emergency Room Visit, 2003. Statistical Brief #111. Rockville, M D: Agency for 1. Healthcare Research and Quality . 2006. 2. Garcia TC, Bernstein AB, Bush MA. Emergency department visitors and visits: Who used t he emergency room in 2007? NCHS data brief, no 38. Hyattsville, MD: National Center for Health Statistics. 2010. with States, 2010, National Center for Health Statistics. Health, United . Hyattsville, MD. 3. special feature on death and dying 2011. Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary. 4. National health statistics reports; no 26. Hyattsville, MD: National Center for Health Statistics. 2010. -Walt C, Proctor BD, Smith JC. Income, poverty, and health insurance coverage in the United States: 2010. U.S. 5. DeNavas Census Bureau. Current population reports, P60– 239. Washington, DC: U.S. Government Printing Office. 2011. Suggested citation 64: Early release of estimates from the Gindi RM, Cohen RA , Kirzinger WK. Emergency room use among adults aged 18– for Health Statistics. Ma rvey, January y 2012. Available from: National Health Interview Su –June 2011. National Center http://www.cdc.gov/nchs/nhis/releases.htm . Emergency Room Use Among Adults: Early Release of Estimates From the National Health Interview Survey 11

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