An Analysis of Emergency Department Utilization Among Pregnant Medicaid Beneficiaries

• Main Author: Culnane, Mary
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2022
• Subjects: Epidemiology; Health sciences; Obstetrics; Obstetrics and gynecology; Public policy
• ISBN: 9798381152050

Nationwide the total number of Emergency Department (ED) visits by Medicaid recipients increased from approximately 128 million visits in 2009 to 143 million visits in 2018. While EDs are a key component of the United States Health Care system, policy makers are concerned about the high costs and overcrowding associated with ED use, particularly among patients who have access to other sources of care. It is acknowledged that ED utilization varies widely across populations and individuals and without information on unique patient populations, policy and clinical interventions remain uninformed and inadequate. Relative to other populations, few studies have investigated use of the ED by pregnant women during the prenatal period. The purpose of this study was to identify factors associated with ED use that can be used to predict the number of ED visits among pregnant Medicaid recipients. Factors that influence the number of ED visits were explored using a Negative Binomial regression model to predict the number of ED visits among pregnant women during the prenatal period. The study utilized Medicaid data collected in the state of Delaware over a 5-year period (fiscal years 2007-2012). Findings revealed that of the 23,824 cases in the study, 40.5% (9,649/23,824) utilized the ED at least once during their prenatal period. Among those who visited the ED, the total number of visits made over the course of the prenatal period was 22,883; of those, 54.4% were made by women who visited the ED less than four times. The remaining 45.6% were made by women who made four or more visits. The Negative Binomial regression model supports the following results. Several sociodemographic characteristics were associated with ED visits. Results from the model revealed that younger pregnant women utilized the ED more than older women in the study cohort. Black pregnant women visited the ED more than women of other races/ethnic groups. Being a pregnant woman with a disability was associated with more ED visits when compared with pregnant women without disabilities. Several clinical factors were also associated with ED visits. Pregnant women with higher health risks, including maternal comorbidities, visited the ED more than pregnant women with no or lower health risks. Pregnant women who were admitted to inpatient care within 24 hours of an ED visit utilized the ED more than those who were not admitted or never visited the ED. Pregnant women with maternal related conditions at the time of the ED visit utilized the ED more than those who visited for other health issues or never visited the ED. Last, pregnant women with longer duration of Medicaid coverage during the prenatal period utilized the ED more than women with shorter duration of Medicaid coverage. This dissertation contributes to the sparse literature on ED utilization by pregnant women enrolled in Medicaid by exploring and identifying factors associated with ED utilization using a methodology appropriate for count data. Such population-specific studies are needed to inform coherent, efficient, and effective programs and policies.