Table 1.
Characteristics of ACSC ED visits by Medicare Patients to All Hospitals and High ACSC Hospitals
| All hospitals | EDs w/ high proportion of ACSCs | EDs w/ high proportion of acute ACSCs | EDs w/ high proportion of chronic ACSCs | |
|---|---|---|---|---|
| N | 2,722 | 559 | 555 | 553 |
| Unique visits (N) | 5,192,729 | 1,009,543 | 997,439 | 1,019,814 |
| Unique patients (N) | 3,670,027 | 710,058 | 719,112 | 712,689 |
| Patient characteristics | ||||
| Median age (IQR) | 78 (72–85) | 78 (71–85) | 79 (72–86) | 78 (71–85) |
| Age | ||||
| 65–74 | 1,844,151 (35.5%) | 372,865 (36.9%) | 349,918 (35.1%) | 383,138 (37.6%) |
| 75–84 | 1,874,734 (36.1%) | 367,253 (36.4%) | 361,901 (36.3%) | 369,433 (36.2%) |
| 85 + | 1,473,844 (28.4%) | 269,425 (26.7%) | 285,620 (28.6%) | 267,243 (26.2%) |
| Female | 3,183,433 (61.3%) | 627,141 (62.1%) | 622,502 (62.4%) | 627,180 (61.5%) |
| Race | ||||
| White | 4,179,259 (80.5%) | 763,046 (75.6%) | 824,608 (82.7%) | 737,814 (72.3%) |
| Black | 711,134 (13.7%) | 181,526 (18.0%) | 113,997 (11.4%) | 215,608 (21.1%) |
| Other | 302,336 (5.8%) | 64,971 (6.4%) | 58,834 (5.9%) | 66,392 (6.5%) |
| Comorbidity count (Elixhauser) | 3 (2–5) | 4 (2–5) | 3 (2–5) | 4 (2–5) |
| Elixhauser comorbidities | ||||
| 0–1 | 995,837 (19.2%) | 168,684 (16.7%) | 189,980 (19.0%) | 157,065 (15.4%) |
| 2 | 796,795 (15.3%) | 154,055 (15.3%) | 156,843 (15.7%) | 151,288 (14.8%) |
| 3 + | 3,400,097 (65.6%) | 686,804 (68.0%) | 650,616 (65.2%) | 711,461 (69.8%) |
| Dual-eligible | 1,261,508 (24.3%) | 300,022 (29.7%) | 257,399 (25.8%) | 311,754 (30.6%) |
| Hospital characteristics | ||||
| Teaching Hosp | ||||
| None | 785 (28.8%) | 131 (24.3%) | 126 (24.2%) | 150 (26.2%) |
| Minor teaching hospital (AMA) | 236 (8.7%) | 15 (2.8%) | 9 (1.7%) | 35 (6.1%) |
| Major teaching hospital (COTH) | 1,701 (62.5%) | 394 (73.0%) | 386 (74.1%) | 388 (67.7%) |
| Bed Size | ||||
| 50–99 | 568 (20.9%) | 142 (26.3%) | 152 (29.2%) | 123 (21.5%) |
| 100–199 | 879 (32.3%) | 193 (35.7%) | 202 (38.8%) | 199 (34.7%) |
| 200 + | 1,275 (46.8%) | 205 (38.0%) | 167 (32.1%) | 251 (43.8%) |
| Ownership | ||||
| For-profit | 511 (19.7%) | 137 (26.9%) | 121 (24.6%) | 142 (26.5%) |
| Public | 354 (13.6%) | 57 (11.2%) | 62 (12.6%) | 63 (11.8%) |
| Non-profit | 1,736 (66.7%) | 316 (62.0%) | 308 (62.7%) | 330 (61.7%) |
| Safety net | ||||
| Highest quartile of DSH | 692 (25.9%) | 175 (32.4%) | 131 (25.1%) | 206 (36.0%) |
| Community characteristics | ||||
| Region | ||||
| Northeast | 473 (17.4%) | 107 (19.8%) | 88 (16.9%) | 132 (23.0%) |
| Midwest | 659 (24.2%) | 114 (21.1%) | 113 (21.7%) | 127 (22.2%) |
| South | 1,074 (39.5%) | 280 (51.9%) | 260 (49.9) | 276 (48.2%) |
| West | 516 (19.0%) | 39 (7.22%) | 60 (11.5%) | 38 (6.6%) |
| Urbanicity (NCHS, 2013) | ||||
| Large central metro | 649 (23.9%) | 132 (24.5%) | 88 (17.0%) | 169 (29.6%) |
| Large fringe metro | 587 (21.6%) | 127 (23.6%) | 125 (24.1%) | 129 (22.6%) |
| Medium/Small metro | 879 (32.3%) | 117 (21.8%) | 148 (28.5%) | 130 (22.8%) |
| Non-metro | 604 (22.2%) | 162 (30.1%) | 158 (30.4%) | 142 (25.0%) |
| Hospital community characteristics Median (IQR) | ||||
| % Poverty | 15.6 (12.0–18.7) | 17.4 (13.9–20.1) | 16.5 (13.1–19.1) | 17.4 (13.9–20.3) |
| Median household income | 50,774 (43,103–58,539) | 46,070.5 (40,530–53,624) | 47,123 (40,751–55,686) | 47,024 (40,957–53,795) |
| Didn’t see doctor because of cost | 13.8 (10.7–17.2) | 14.8 (12.4–18.4) | 14.5 (11.5–17.8) | 14.7 (12.2–17.9) |
| High housing costs | 34.4 (28.8–40.5) | 31.7 (26.9–38.5) | 30.5 (26.3–36.8) | 33.8 (28.3–41.1) |
| High school education or higher | 86.9 (82.5–89.7) | 84.4 (78.7–88.4) | 85.0 (79.7–88.9) | 84.8 (79.6–88.2) |
| Food insecurity | 15.3 (12.7–17.6) | 16.1 (13.6–17.9) | 15.3 (12.9–17.6) | 16.2 (13.6–18.3) |
| Federally qualified health centers /100 K | 1.3 (0.5–2.7) | 1.4 (0.5–2.8) | 1.3 (0.4–2.8) | 1.4 (0.5–2.8) |
| Primary care / 100 K | 72.1 (53.5–92.7) | 61.3 (45.1–82.1) | 61.1 (44.9–81.5) | 65.5 (48.2–85.0) |
| % White | 79.5 (64.2–89.4) | 79.9 (63.0–91.8) | 81.7 (68.9–91.8) | 76.2 (62.1–89.7) |
| % Black | 8.3 (2.7–18.6) | 10.5 (2.8–22.2) | 7.2 (2.5–18.7) | 12.5 (4.1–24.4) |
| % Hispanic | 7.6 (3.4–19.6) | 5.5 (2.3–19.1) | 5.7 (2.4–17.1) | 6.7 (2.6–19.7) |
Notes. “ED” emergency department, “ACSCs” ambulatory care sensitive conditions, “DSH” Disproportionate Share Hospital
All patient characteristics are at the visit level; all hospital, community, and hospital community characteristics are at the hospital level