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V Swetha Jeganathan, Maria A Woodward, Brian Craig Stagg, Nidhi Talwar, Joshua D Stein; Large Geographic Variation in Rates of Visits to the Emergency Department for Ocular Problems Among 306 US Communities. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5083.
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With the recent Affordable Care Act passage, emergency department (ED) use has increased dramatically. Many ED providers have limited training to manage eye complaints, so an ED may not be the ideal setting to handle non-urgent ocular problems. We determined the extent of geographic variation in urgent, non-urgent, and any visits to the ED for ocular problems in a large group of insured US patients.
We studied 11160833 beneficiaries enrolled in a nationwide managed care network during 2001-2014. Using billing codes, we identified all ED visits for ocular problems. Ocular conditions were categorized as urgent, non-urgent, or other. Urgent ocular conditions were defined as sight or life threatening conditions or those causing considerable pain. Examples include temporal arteritis, retinal detachment and globe rupture. Non-urgent ocular conditions were defined as conditions such as dry eyes and conjunctivitis that rarely affect vision or cause much discomfort, and thus rarely require urgent care in an ED. Numbers of visits to an ED for urgent, non-urgent, and any ocular problem per 10000 person-years were compared among 306 US communities.
376680 patients (3.4%) went to the ED for ≥1 ocular problems during the study period. Visits to the ED for ocular problems varied substantially from as low as 16.1/10000 person-years in Bangor, ME to as high as 153/10000 person-years in Elyria, OH. Among the 306 communities, 3 of the 10 communities with the lowest rates of ED visits for ocular problems were in CT and 9 of the 10 communities with the highest visit rates for ocular problems were in MI, OH, and PA. The West coast and Northwest regions had fewer visits for non-urgent ocular problems compared to the upper Midwest and the mid-Atlantic regions. We found a 13.4-fold difference between communities with the lowest (Bangor, ME) and highest (Elyria, OH) visit rates for non-urgent eye problems, range 3.8-50.9/10000 person-years. The difference between the lowest and highest visit rates for urgent ocular issues ranged from 0 to 12.4/ 10000 person-years.
There is considerable geographic variation in ED use for ocular problems. By understanding the reasons underlying differences in rates of visits, especially for non-urgent eye problems, researchers can identify ways to improve eye care quality and reduce costs.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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