June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Revisit rates and associated costs after emergency room encounters for ophthalmic conditions
Author Affiliations & Notes
  • Amee D Azad
    Ophthalmology, Stanford University, Stanford, California, United States
  • Evan Chen
    Ophthalmology, Yale University School of Medicine, New Haven, Connecticut, United States
  • Ravi Parikh
    Ophthalmology, NYU Langone Health, New York, New York, United States
    Manhattan Retina and Eye Consultants, New York, New York, United States
  • Benjamin Erickson
    Ophthalmology, Stanford University, Stanford, California, United States
  • Prithvi Mruthyunjaya
    Ophthalmology, Stanford University, Stanford, California, United States
  • Footnotes
    Commercial Relationships   Amee Azad, None; Evan Chen, None; Ravi Parikh, None; Benjamin Erickson, None; Prithvi Mruthyunjaya, None
  • Footnotes
    Support  Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number T35AG049685 (Recipient: EC). The sponsor or funding organization had no role in the design or conduct of this research.
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 685. doi:
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    • Get Citation

      Amee D Azad, Evan Chen, Ravi Parikh, Benjamin Erickson, Prithvi Mruthyunjaya; Revisit rates and associated costs after emergency room encounters for ophthalmic conditions. Invest. Ophthalmol. Vis. Sci. 2021;62(8):685.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To characterize emergency department (ED) revisit rates related to ophthalmologic conditions, variation by diagnosis, and costs.

Methods : We identified 3- and 30-day ED revisit rates by diagnosis, diagnosis categories and demographic groups. Costs associated with revisits were described as a percentage of index visits and adjusted to 2016 US dollars using the Consumer Price Index. We utilized logistic multivariable regression analysis to identify factors significantly associated with revisits.

Results : Among a total of 828,125 index ED encounters from 2007-2016 with an ophthalmic condition as a primary diagnosis, the 3- and 30-day revisit for the overall cohort was 2.5% and 4.1% respectively. Conditions of the cornea and external disease comprised the majority of index diagnoses (65.2%) but were associated with low rates of 30-day revisit (3.1%). Thirty-day revisits rates were highest for conditions related to cataract and lens disorders (28.3%) as well as glaucoma (15.9%). Nearly all (99%) patients revisiting the ED with cataract and lens disorders had a cataract-related procedure within 30 days of the index encounter. In multivariable analysis, younger adults, those with insurance plans lacking out-of-network coverage and cases involving an ophthalmologist were associated with a significantly higher likelihood of a revisit within 3-days of an index visit. Conversely, patients with higher out-of-pocket costs during an index visit were significantly less likely to revisit in the same period.

Conclusions : Revisit rates for ocular conditions overall are low but varied by diagnosis category. Cataract and lens disorders had the highest 30-day revisit rate (with the vast majority within the 30-day postoperative period) followed by glaucomatous disorders. Younger patients, those with insurance lacking out-of-network coverage, those with lower OOP costs on an index visit and patients with an ophthalmologist participating in their ED care all had higher revisit rates. ED revisits for ocular conditions may be preventable with timely follow-up care, particularly for patients presenting in the acute post-operative period following cataract surgery.

This is a 2021 ARVO Annual Meeting abstract.

 

Figure 1. Revisit rates within 30 days of an index emergency department visit. Rates are non-cumulative. Among patients with more than one revisit, only the first was included.

Figure 1. Revisit rates within 30 days of an index emergency department visit. Rates are non-cumulative. Among patients with more than one revisit, only the first was included.

 

Figure 2. Total emergency department costs among revisit encounters by diagnosis category.

Figure 2. Total emergency department costs among revisit encounters by diagnosis category.

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