Association Between Usual Clinician Presence and Emergency Department Revisitation

Emergency department (ED) visit rates among older adults are increasing, often due to ambulatory care sensitive conditions (ACSCs) that may have been managed through access to a usual clinician-a provider who offers regular outpatient care. We sought to characterize ACSC-related ED visits and all-cause 30-day ED revisits among ED visits of older adults with and without a usual clinician.

We conducted a pooled cross-sectional analysis of 2015-2020 Medicare Current Beneficiary Survey (MCBS) data linked to traditional Medicare claims of adults 65 and older. We compared ED visits that did and did not have a usual clinician with 3:1 propensity score matching on age, gender, race, chronic condition number (2+ vs. < 2), and geographical area. Our primary outcome was the proportion of ACSC-related Medicare beneficiary ED visits that were and were not associated with a usual clinician. Our secondary outcome was the presence of an all-cause ED revisit in the 30 days following the initial ED visit.

We examined 22,484 ED visits between 2015 and 2020, representing over 86 million ED visits nationally. Among ED visits by older adults, 20,849 (92.7%) were among those with a usual clinician. The proportion of ACSC-related ED visits by older adults with and without a usual clinician did not differ (14.8% vs. 14.7%, adjusted marginal difference [AMD] -0.20%, 95% CI: -2.17-1.78, p = 0.97). However, the proportion of all-cause 30-day ED revisits with a usual clinician among older adults was lower when compared with those without a usual clinician (25.6% vs. 35.9%, AMD 7.55%, 95% CI: 4.97-10.13, p < 0.001).

Emergency visits by older adults for ACSCs were similar regardless of the presence of a usual clinician; however, ED visits among older adults with a usual clinician were less likely to be followed by an ED revisit within 30 days.