A MULTISITE SURVEY OF FACTORS CONTRIBUTING TO MEDICALLY UNNECESSARY AMBULANCE TRANSPORTS

Objectives: To determine the social and demographic factors associated with medically unnecessary ambulance utilization, and to determine th e willingness of patients to use alternate modes of transportation to the ED. Methods: A multisite prospective survey was conducted of all p atients arriving by ambulance to 1 suburban and 4 urban EDs in New Yor k State during a 1-week period, Results: For 626 patients surveyed, 71 (11.3%) transports were judged medically unnecessary by the receiving emergency physicians using preestablished guidelines. The patient's t ype of medical insurance and age were significant predictors of unnece ssary ambulance transport (stepwise forward logistic regression analys is), Of the 71 patients whose ambulance transports were deemed medical ly unnecessary, 42 (59%) were Medicaid recipients and 53 (74%) were <4 0 years of age, The most common reason for using ambulance transport w as lack of an alternate mode of transportation (38.5%), although 82% w ould have been willing to use an alternate mode of transportation if i t had been available, Of those who had medically unnecessary ambulance use, 30% indicated that they would not pay for the ambulance service if billed and 50% believed the cost of their ambulance transports was <$100. More than 85% of the patients whose ambulance transports were d eemed medically unnecessary were unemployed; and nearly 85% reported a net annual income of <$20,000, While 33% had a primary care provider, only 22% had attempted to contact their doctors before requesting an ambulance. Conclusions: Patient age <40 years and Medicaid coverage we re associated with medically unnecessary ambulance use. Those patients for whom ambulance use was considered medically unnecessary commonly had no alternate means of transportation. Providing alternate means of unscheduled transportation may reduce the incidence of unnecessary am bulance use.