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AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 1.3 MB

Date submitted: October 26, 2012

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
What is the comparative effectiveness of interventions to reduce non-emergent Emergency Department visits?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
-Availability and utilization of community health centers, free clinics, public clinics, primary care medical homes, hospital based programs (hospital discharge and follow up)
-Interventions to identify those at risk for inappropriate use of emergency services
-Educational approaches for reducing inappropriate use of emergency departments
-Changes in administrative policy or Medicaid payments
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
Special health care needs patients
Patients with disabilities
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
Insured patients
Patients with chronic diseases (asthma, COPD, CHF, diabetes)
Uninsured patients
Underinsured patients
Low income patients
Vulnerable populations
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
Improved non-emergent and chronic disease management
Improved compliance with treatment
Reduced burden on health care system
Increased continuity of care
Reduced medication errors
Reduced inappropriate use of medications
Reduction in unnecessary testing and/or duplication of testing
Reduction in readmissions
Decrease in variation in practice
Describe any health-related risks, side effects, or harms that you are concerned about.
Diversion or delay in seeking care
Exacerbation of existing conditions
Disease progression or death

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Cardiovascular disease, including stroke and hypertension
  • Depression and other mental health disorders
  • Diabetes mellitus
  • Functional limitations and disability
  • Infectious diseases, including HIV/AIDS
  • Obesity
  • Peptic ulcer disease and dyspepsia
  • Pregnancy, including preterm birth
  • Pulmonary disease/asthma
  • Substance abuse
AHRQ Priority Populations
  • Low income groups
  • Minority groups
  • Women
  • Children
  • Elderly
  • Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care
Federal Health Care Program
  • Medicaid
  • Medicare
  • State Children's Health Insurance Program (SCHIP)


Describe why this topic is important.
•At least one-third of all ED visits are non-urgent or ambulatory care sensitive (ACS) and therefore treatable in primary care settings.

•Americans are increasingly using hospital EDs for non-emergent and even routine health care problems. This use is linked to the growth of the number of uninsured individuals but is also closely tied to reduced access to a regular source of care.

•Almost 20% of ED visits are made by Medicaid beneficiaries who account for less than 15% of all US residents

•Studies have shown that having a regular source of health care (or a "medical home") reduces ED use significantly, not only for healthy patients, but for those who are already sick and have greater health care needs.

•Based on recent Medicaid statistics: 90% of ED visits result in discharge from the ED; 20% of visits are for emergent conditions; at least 1/3 of all visits are for non-urgent health problems. (Partnership for Medicaid Report, 2003)
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
This question was prioritized by stakeholders engaged in the Topic Identification project conducted by the Oregon Evidence-based Practice Center for the Medicaid Medical Directors Learning Network.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
If yes, please explain:
There is general agreement among clinicians and policymakers on the importance of reducing emergency department utilization for non-emergent health care needs, but there is uncertainty regarding the effective strategies to accomplish this.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
Professional associations, policymakers, and insurers all have an interest, and they may implement or promote the effective strategies found to achieve reductions in emergency department utilization for non-emergent health care needs.

Medicaid Medicare sponsors may use this report to inform health policy and may implement effective strategies
Describe the timeframe in which an answer to your question is needed.
Not aware of a specific timeline
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
Patients with chronic diseases (e.g., asthma, COPD, CHF, diabetes)
Uninsured patients
Underinsured patients
Low income patients
Special health care needs patients
Patients with disabilities

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Researcher
Are you making a suggestion as an individual or on behalf of an organization?
Organization - Medicaid Medical Directors Learning Network
Please tell us how you heard about the Effective Health Care Program