Pines JM, et al. - Researchers performed a comparison of case mix, hospitalization rates, length of stay (LOS), and resource use in independent Freestanding Emergency Departments (FSEDs) and Hospital-based Emergency Departments (H-EDs). In the analysis of data FSEDs (2013–2015) in Texas and Colorado, a greater proportion of younger patients with fewer comorbidities and more injuries and respiratory system diseases were noted. Almost all of these patients had private health insurance. LOS was considerably shorter and hospital admission rates lower at FSEDs, as well as the use of some diagnostic testing when restricted to < 65 years, privately insured, and nonambulance patients in both samples.

Methods

• Researchers compared data from 74 FSEDs (2013–2015) in Texas and Colorado to H-ED data from the 2013–2014 National Hospital Ambulatory Medical Care Survey.
• They identified large differences in visit characteristics (e.g., payer and case mix) between patients that use FSEDs compared to H-EDs in the unrestricted sample.
• Hence, the analysis was restricted to patients commonly treated in both settings (<65 years, privately insured, nonambulance) and inverse propensity score weighting (IPW) was used to balance the two settings on observable patient characteristics.
• Comparison of ED LOS and as well as hospital admission rates and resource utilization rates in the IPW-weighted samples was then performed.

Results

• Compared to H-EDs, FSEDs saw more young adults (age 25–44) and fewer older adults (age 45–64) before balancing.
• Fewer comorbidities, more injuries and respiratory infections, and fewer diagnoses of chest or abdominal pain were noted among FSED patients.
• LOS for FSED visits was 46% shorter (60 minutes) than H-ED patients in balanced samples, .
• In FSEDs, hospital admission rates were 37% less overall (95% confidence interval = -51% to -23%); the rates varied considerably by primary discharge diagnosis.
• At FSEDs, X-ray and electrocardiogram use was significantly lower.
• However, others measures of resource utilization were similar (ultrasound, computed tomography scans, and laboratory tests) at FSEDs and H-EDs.