Emergency Department Utilization After the Implementation of Massachusetts Health Reform

From the Annals of Emergency Medicine:

Study objective: Health care reform in Massachusetts improved access to health insurance, but the extent to which reform affected utilization of the emergency department (ED) for conditions potentially amenable to primary care is unclear. Our objective is to determine the relationship between health reform and ED use for low-severity conditions.

Methods: We studied ED visits, using a convenience sample of 11 Massachusetts hospitals for identical 9-month periods before and after health care reform legislation was implemented in 2006. Individuals most affected by the health reform law (the uninsured and low-income populations covered by the publicly subsidized insurance products) were compared with individuals unlikely to be affected by the legislation (those with Medicare or private insurance). Our main outcome measure was the rate of overall and low-severity ED visits for the study population and the comparison population during the period before and after health reform implementation.

Conclusion: Although overall ED volume continues to increase, Massachusetts health reform was associated with a small but statistically significant decrease in the rate of low-severity visits for those populations most affected by health reform compared with a comparison population of individuals less likely to be affected by the reform. Our findings suggest that access to health insurance is only one of a multitude of factors affecting utilization of the ED.

Monitoring in the ER can avoid unneeded CT scans of kids

From the Boston Globe:

A study published today in the journal Pediatrics suggests that careful monitoring for several hours in the emergency room can cut the rate of CT scans in half for kids with moderate head injuries that cause vomiting, temporary confusion or a concussion. “Careful observation may be an effective strategy for reducing CT use,” says study author Dr. Lise Nigrovic, an attending physician at Children’s Hospital Boston. “These are very powerful tests that deliver high amounts of radiation with potential risks to children.”

Weekend Admission May Raise Risk of Death

From MedPage Today:

Patients admitted for an emergency on a weekend are more likely to die in the hospital than those admitted on a weekday, researchers found.In an analysis of nearly 30 million patients, the inhospital mortality rate was significantly higher for those admitted on the weekend across a range of diagnoses (2.7% versus 2.3%, P<0.001), according to Rocco Ricciardi, MD, MPH, of Tufts University Medical School in Burlington, Mass., and colleagues.

In a multivariate analysis that adjusted for age, sex, race, income, payer, comorbidities, and hospital characteristics, weekend admission was associated with a 10.5% greater likelihood of dying