1. For many minority patients, the emergency department (ED) serves as a primary healthcare facility. Minorities represent more than half of the uninsured population (Cardelli & Chiapa, 2007). Although many uninsured patients utilize the ED for non- urgent care, privately insured patients do not frequent the ED for care (Khaliq & Broyles, 2006). Utilization of EDs is not based solely on race or ethnicity. Additional factors include: income (Suruda, Burns, Knight, & Dean, 2005) insurance status (Todd, Armon, Griggs, Poole, & Berman, 2006) access to primary care (Cardelli & Chiapa, 2007) cost of care (Baker & Baker, 1994) The disparity in ED utilization is exacerbated by the cost of care being markedly more expensive than the cost of care in a primary healthcare setting (Baker & Baker, 1994; Machlin, 2006; Newton, Keirns, Cunningham, Haywood, & Stanley, 2008). The high cost of care places a financial strain on minority patients (Cheong, Feeley, & Servoss, 2007) who reportedly earn lower incomes than their White counterparts (Boudreaux, Edmond, Clark, & Camargo, 2003). The existence of free clinics helps to offset the financial burden for minorities seeking treatment in the ED (Isaacs & Jellinek, 2007). Is access to primary care the solution we have been searching for regarding emergency department utilization differences between minority and non-minority patients? Marquianna Griffin, MSPH; Stephen Notaro, PhD; I. Shevon Harvey, DrPH Department of Community Health at University of Illinois at Urbana-Champaign INTRODUCTION Black, non-Hispanic patients had higher mean number visits to the ED (1.41) than Caucasian patients (1.04). OBJECTIVE METHODOLOGY SELECTED RESULTS CONCLUSIONS LIMITATIONS FUTURE RESEARCH RECOMMENDATIONS 1.Compare ED utilization between minority and non-minority patients 2.Identify which factors contribute to minority patients utilizing the ED in greater numbers than their non-minority counterparts 3.Discuss accessible primary care as a solution for patients utilizing the ED for their healthcare needs Demographic Information Form inquired about patients’ demographic characteristics and health service utilization (specific focus on ED utilization) Sample Data compiled between 2005 and 2007 Surveys were completed by first-time patients at the Champaign County Christian Health Center, a free health clinic in Champaign, IL (n=971) Non-Hispanic Black/African American, non-Hispanic White/Caucasian, Hispanic, Other Statistical analysis The Statistical Package for Social Sciences (SPSS) was utilized to analyze the data A chi-square analysis, bivariate statistical analysis (ANOVA) and generalized linear model were utilized to analyze the data LocationRace/ethnicityχ 2, p WhiteBlackHispanic37.72, p=0.000 Hospital12.8%11.4% Emergency Room14.4%16.4% 5.7% Community Health Ctrs12.2%15.0%28.6% Other Healthcare 5.6% 8.2% 5.7% Nowhere/Don’t Know55.0%49.1%48.6% VisitsRace/ethnicityχ 2, p WhiteBlackHispanic45.71, p=0.000 0 ED visits61.0%52.5%81.7% 1 ED visit18.8%18.4%11.8% 2 ED visits 9.5%11.9% 4.3% 3 ED visits 4.0% 7.3% 2.2% 4 ED visits or more 6.7%10.0% 0.0% Race/ethnicityFrequencyF, p MeanSD5.88, p=0.001 White1.042.62 Black1.412.95 Hispanic0.270.66 Race/ethnicityFrequencyF, p MeanSD3.07, p=0.027 White$11,005.58$10,702.00 Black $8,050.00$10,704.09 Hispanic$10,044.55$10,376.87 Characteristics of patients with high ED utilization were: Minority (Black, non-Hispanic) Lower income Visits to the ED for non-urgent conditions Residing in female-headed household Black, non-Hispanic patients tend to earn lower incomes, reside in female headed households, and visit the ED for non-urgent care in greater numbers in comparison to their White, non-Hispanic counterparts Access to primary care can Reduce the number of patients visiting the ED for their primary care Potentially reduce the economic strain on the healthcare system resulting from low-income patients that incur ED cost for their primary care The existence of free health clinics provides a primary healthcare alternative to the ED Self-reported data Open-ended questions Insurance coverage not collected on survey instrument Number of Hispanic and “Other” patients relatively small Future studies should collect data on healthcare utilization and insurance coverage to determine if uninsured minorities frequent the ED because they lack insurance coverage If data is utilized in free clinic setting: Questions should provide concrete responses for data analysis Medical records should be utilized for diagnosis as opposed to self-reported reason for visit Research instrument should ask patients if they have insurance coverage Analysis should study relationships between ED utilization and insurance coverage Higher percentages of Black, non-Hispanic patients reported they had 2 or more visits to the ED within the previous year 16.4% of Black, non-Hispanic patients reported they would have sought treatment in the ED for healthcare in the absence of CCCHC in comparison to 14.4% of White, non-Hispanic patients Hispanic and Black, non-Hispanic patients reported lower mean annual incomes than White, non-Hispanic patients (see Table 4) The majority of White and Black, non-Hispanic patients visited the ED for non- urgent care (67.7% and 76.3%, respectively), with Black, non-Hispanic patients exhibiting a larger percentage for non-urgent care Race/ethnicityFemale Head FrequencyF, p (race/eth) F, p (f head) MeanSD5.48, p<0.001 1.54, p=0.216 WhiteYes1.092.62 No0.891.98 BlackYes1.572.77 No1.363.45 HispanicYes0.300.65 No0.260.61 Table 1 - Mean Number of Visits to the ED within the Previous Year Table 5 - Mean Yearly Income Black, non-Hispanic patients residing in female-headed households demonstrated higher mean ED visits than White, non-Hispanic patients Table 4 - Mean Number of ED Visits in Previous Year by Female Head of Household Table 2 - Percentage of Categorized Number of ED Visits in Previous Year Table 3 – Percentage for Location of Alternate Healthcare SELECTED RESULTS cont. Graph 1 - Urgency of ED Conditions (White, non-Hispanic Patients) Graph 2 - Urgency of ED Conditions (Black, non-Hispanic Patients)