1. Understanding the Relationship between Barriers to Timely Primary Care and Emergency Department Utilization across Insurance Categories – Report from the 1999-2011 National Health Interview Survey (NHIS) Rohan J. Bandara, Mary M. Gerkovich, PhD, Steve Simon, PhD, Karen B. Williams, PhD, Lakshmi Venkitachalam, PhD; Department of Biomedical and Health Informatics - UMKC School of Medicine Introduction In the United States, emergency departments (EDs) serve as a source of primary care and portal of hospital admissions Compared to adults with private insurance, ED use is typically higher among adults with publicly funded health insurance but similar in those who are uninsured The burden of barriers to timely care varies across insurance status and is associated with increased risk of ED visits The interrelationship between barriers and insurance status and their association to ED use, however, is not well understood. Objective To examine the association of perceived barriers to timely primary care and self-reported ED use, and the interaction with source of insurance among non-institutionalized US adults Methods Data Source: Data from 1999-2011 NHIS, a cross sectional survey conducted annually among non-institutionalized US adults sampled using stratified multistage probability design Analysis cohort: 378,502 adults 18 years representing 216.5 million adults Exposures (based on self-report) Barriers to care in the past 12 months: Couldn't get through on telephone; Couldn't get an appointment soon enough; Waiting too long in the physician's office; Office was not open when you could get there; No Transportation Source of Insurance: Medicare; Medicaid; Private; Other; Uninsured Outcome Any self-reported ED visit during the past 12 months Data Analysis National estimates and 95% confidence intervals (CI) were obtained using appropriate sampling weights Cohort characteristics summarized as frequencies and 95% CI Logistic regression models were used to estimate relative odds and 95% CI of 1 ED visits and test for significance of interaction Table 1: Weighted distribution of the characteristics of the study cohort Table 2: Relative odds of 1 ED visits by self- reported barriers and source of insurance Summary & Conclusion Between 1999 and 2011, approximately 1 in 5 adults reported 1 ED visits and 1 in 10 adults reported 1 barriers to timely primary care in the past 12 months In models that included both variables, barriers to timely primary care and source of insurance were independently associated with the odds of self-reported ED visits Among non-institutionalized adults in the US, the source of insurance was seen to influence the association between perceived barriers to timely care and ED use Strengths and Limitations Retrospective analysis of secondary data Large sample size, can generate national estimates Includes data on self-reported barriers to timely primary care Cannot establish causality and is subject to confounding Future Steps Determine whether the observed association persists after controlling for socio-demographic and clinical characteristics Examine temporal trends in the observed association Acknowledgement Supported by UMKC School of Medicine Sarah Morrison Student Research Award; Approved by UMKC AHSIRB Protocol #: 13-02 - NHSR Results Figure 2: Interaction between insurance type and barriers to timely primary care Figure 1: Distribution of 1 ED visits by self- reported barriers and source of insurance Characteristic Frequency (millions) % (95% CI) Age 18-44Years109.950.8 (50.6-51.0) 45-64Years71.232.9 (32.7-33.1) 65 Years35.416.4 (16.2-16.5) Sex Female112.251.8 (51.6-52.0) Race/Ethnicity Non-Hispanic White152.770.5 (70.4-70.7) Non-Hispanic Black24.511.3 (11.2-11.4) Hispanic27.112.5 (12.4-12.6) Non-Hispanic Asian8.53.9 (3.86-4.0) Non-Hispanic Other3.61.7 (1.6-1.73) Socioeconomic status Currently Employed137.763.7 (63.6-63.9) Source of Insurance Private125.257.8 (57.5-58.2) Medicare38.317.7 (17.4-17.9) Medicaid10.95.0 (4.9-5.2) Other5.72.6 (2.5-2.7) Uninsured35.316.3 (16.1-16.5) Barriers to timely Primary Care 1 Barriers21.410.0 (9.8-10.1) ED Use 1 ED Visits43.220.2 (20.0-20.4) Odds Ratio95% CI Model 1: Any Barriers No Barriers1.00Reference 1 Barriers2.092.03 - 2.15 Model 2: Source of Insurance Private1.00Reference Medicare1.761.72 - 1.80 Medicaid3.253.13 - 3.37 Other1.911.80 - 2.02 Uninsured1.271.23 - 1.31 Model 3: Any Barriers and Source of Insurance Barriers No Barriers1.00Reference 1 Barriers2.011.95 - 2.07 Source of Insurance Private1.00Reference Medicare1.761.72 - 1.81 Medicaid3.113.00 - 3.23 Other1.831.73 - 1.94 Uninsured1.261.23 - 1.30 Adults reporting 1 barriers by source of insurance: 17% of Medicaid; 15.0% of Other Insurance; 10% of Uninsured; 10% of Medicare; and 9% of Private Insurance Contact Information Rohan Bandara: rjbzrc@mail.umkc.edurjbzrc@mail.umkc.edu Lakshmi Venkitachalam: venkitachalaml@umkc.eduvenkitachalaml@umkc.edu