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Health Care Final 10-15-09 -   2.1 - DSHS - Avoidable Emergency Department Visits

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Health Care Final 10-15-09
Healthy State
Economic Recovery
Action Plan

2.1 - DSHS - Avoidable Fee-For-Service Emergency Department (ED) Visits

Is the Percentage of Avoidable ED Visits Going Down?

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Data Notes
Data Source: Health Watch Technology Single Data Source, August 10, 2009
Measure Definition: Avoidable Emergency Department Utilization
Target Rationale: One of the 12 recommendations set forth in the Blue Ribbon Commission to reduce unnecessary ED utilization.
Link to Agency Strategic Plan: The strategic plan calls for implementation of pilot projects to reduce unnecessary ED utilization by clients, and to--based on results of the pilot projects--replicate statewide.
Relevance: Healthcare should be delivered in the most appropriate, cost-effective setting available.
Notes: (optional) Period:  State Fiscal Year (SFY) 2000 to SFY 2008
Also Available
Action Plan: yes
Extended Analysis yes

 Drill Down Measures

 Summary Analysis

For DSHS FFS clients, the percent of ED visits that were avoidable remained fairly stable from SFY 2000 through SFY 2008. However, the number of avoidable ED visits steadily increased during the same period. This measure tracks avoidable ED visits as one indicator of access to care. A dearth of primary care providers has been cited as one of the many complex issues driving recent ED utilization trends.

  • From SFY2000 to SFY2008, the number of avoidable ED visits per client increased almost 18.2%, from 23.1 visits per 100 clients to 27.3 per 100 clients.
  • Between SFY2007 and SFY2008, there was an increase in the number of avoidable ED visits per 100 clients of nearly 8%.

The increase in avoidable visits per 100 clients is partly due to a decline in the FFS population and a corresponding change in its composition. As younger, healthier clients have been moved from FFS to managed care, there has been a decrease in the number of FFS clients from 514,042 to 507,536 between SFY 2007 and SFY2008 and an increase in the number of total ED visits from 281,561 to 301,504 during the same period. This results in the percentage of ED visits remaining stable although the number of total ED visits and avoidable ED visits per 100 clients is increasing.

As shown on the graph in Chart 2 to the left, total ED visits increased from 177,903 to 301,504 between SFY 2000 and 2008. This 7.2% per year average increase is not due solely to caseload growth. During the same period, the DSHS FFS Medical Programs average client caseload increased from 481,835 to 510,789, which represents only a 4.7% average annual increase. For every 100 of those clients, the number of ED visits increased from 49.6 visits to 57.1 visits from SFY 2000 to 2008, a 2.4% per year increase.

In SFY 2008, 23 counties were below the statewide average of 27.3 avoidable ED visits per 100 clients. 16 counties were above the statewide average, with 3 decreasing from the prior year while 13 increased.