Emergency medical care: Types, trends, and factors related to nonurgent visits

Objectives: To describe and compare national trends in ED use by statistica l analyses on data from the 1992 to 1996 National Hospital Ambulatory: Medi cal Care Survey (NHAMCS) with a special interest in factors related to nonu rgent visits. Methods: The NHAMCS collects data for ED visits using a four- stage national probability sample. Data from 135,723 ED visits in 1992-1996 were analyzed using the chi-square test for proportions with logistic regr ession modeling for multivariate analysis. Results: Mere than half of the E D visits were considered nonurgent, There was a decreasing trend for nonurg ent ED visits over the first three years of the sample (54.0% to 52.1%, p < 0.05). The proportion of ED visits for nonurgent care bounced back in 1995 (54.7%) and 1996 (54.1%). Significant variation existed in the proportion of nonurgent care visit based on disease category, age, race, and insurance coverage status. Marked variation in nonurgent visits also existed among g eographic regions and types of hospital ownership. Conclusions: Analyses of data from the NHAMCS identify trends in ED use. The study of nonurgent ED visits with this database has inherent methodologic problems such as retros pective coding and: geographic coding inconsistency. Since the nonurgent vi sit: is clearly linked to certain social-demographic factors, addressing th ese underlying issues by establishing a comprehensive health care system is a priority.