QuickStats: Rate of Emergency Department (ED) Visits by Homeless Status and Geographic Region§ — National Hospital Ambulatory Medical Care Survey, United States, 2015–2018

December 18, 2020

 

During 2015–2018, there were annual averages of 42 ED visits per 100 total population, 42 ED visits per 100 nonhomeless persons, and 203 ED visits per 100 homeless persons.

Within each region, the rate of ED visits among homeless persons was higher than the rate for nonhomeless persons.

The rates of visits for nonhomeless persons did not differ by region; however, among homeless persons, visit rates were higher in the West (268) than in the Northeast (127) and South (170) and higher in the Midwest (234) than in the Northeast.

Source: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 2015–2018. https://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a8.htm


Opioid-involved Emergency Department Visits in the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey

December 15, 2020

Questions for Geoffrey Jackson, Health Statistician and Lead Author of “Opioid-involved Emergency Department Visits in the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey.”

Q: Why did you decide to research opioid-involved emergency department (ED) visits?

GJ: From 2005 through 2014, it is estimated that the rate of ED visits due to opioid use increased 99.4%, from 89.1 per 100,000 population in 2005 to 177.7 per 100,000 population in 2014. We were struck by the large increase and know that ED data can provide critical information on opioid use-related treatments, such as opioid use disorder treatment, detoxification for safe opioid withdrawal, and management of adverse effects. NCHS hospital surveys can be used to monitor trends in opioid overdoses, as well as other opioid-related morbidity and mortality measures.


Q: Can describe the difference between the difference between the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey?

GJ: Even though both surveys collect data from hospital emergency departments, the mode of data collection differs between the two surveys. The National Hospital Care Survey (NHCS) is an all-electronic data collection of administrative claims or billing data. NCHS receives all inpatient, ED, and outpatient hospitals for a calendar year.  In addition, to patient demographics, diagnoses, procedures, laboratory tests, and medications, NHCS collects patient name, address, and Social Security number, which allows patients to be followed over time and linkage to external data sources, such as the National Death Index, providing a more complete picture of patient care and post-acute mortality.

In contrast, the National Hospital Ambulatory Medical Care Survey (NHAMCS) data collection relies on medical record abstraction by U.S. Census Bureau field representatives during a 4-week period. A random sample of about 100 ED visits are selected from all visits during the reporting period, and data are manually abstracted directly from medical records by Census staff. NHAMCS collects similar information as NHCS, but NHAMCS does not collect patient identifiers.  As a consequence, NHAMCS data cannot be linked to other sources nor can patients be collected over time.


Q: Was there a specific finding in the data that surprised you from this report?

GJ: One finding that surprised me was the increase in percentage the patients that died of an opioid overdose 90 days after their hospital visits. Specifically, of the patients with an opioid-involved ED visit that died with 91 and 365 days after their ED visit, 20.6% died with an opioid overdose, compared to approximately 15% that died within 90 days post-ED visit died of an opioid overdose.


Q: Is this the most recent data you have on this topic?

GJ: The most recent NHCS data available in the NCHS Research Data Center (RDC) are from 2016. The 2016 NHCS data are linked to the 2016 and 2017 National Death Index and include information on specific drugs mentioned on the death certificate from the Drug-Involved Mortality file. Additionally, the 2016 NHCS RDC data include identification of opioids using an enhanced methodology that uses natural language processing and machine learning techniques. The most recent NHAMCS public use data file available are from 2018.


Q: What is the take home message for this report?

GJ: NHCS is an important data source for studying opioid-involved ED visits. Through the collection of patient identifiers, the data can be linked to the National Death Index to provide information on post-acute mortality. The information on post-acute mortality is not available in other hospital data sources. Even though the NHCS data are not nationally representative, the NHCS data have similar distributions to NHAMCS data for national estimates of ED visits of male and female opioid-involved ED visits and for persons aged 35 and over.


QuickStats: Percentage of Emergency Department (ED) Visits Made by Adults with Influenza and Pneumonia That Resulted in Hospital Admission, by Age Group

December 11, 2020

During 2017–2018, 37.2% of ED visits for influenza and pneumonia by adults aged 18 years or older resulted in a hospital admission.

The percentage increased with age from 14.4% for adults aged 18–54 years to 46.9% for adults aged 55–74 years and 69.7% for adults aged 75 years or older.

Source: National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey, 2017–2018. https://www.cdc.gov/nchs/ahcd/ ahcd_questionnaires.htm.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6949a6.htm


QuickStats: Percentage of Emergency Department Visits for Acute Viral Upper Respiratory Tract Infection at Which an Antimicrobial Was Given or Prescribed by Age — United States, 2010–2017

February 14, 2020

From 2010–2013 to 2014–2017, the percentage of emergency department (ED) visits for acute viral upper respiratory tract infection that had an antimicrobial given or prescribed, hereafter referred to as ED visits, decreased from 23.4% to 17.6%.

A decline was also seen for ED visits by children, decreasing from 17.9% to 10.1%, but a decline was not seen for ED visits by adults. In both periods, the percentage of ED visits by adults was higher than the percentage of ED visits by children.

Source: National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey, 2010–2017. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/NHAMCS.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6906a6.htm


QuickStats: Percentage of Emergency Department Visits for Pain at Which Opioids Were Given or Prescribed, by Geographic Region of the Hospital — United States, 2005–2017

January 17, 2020

The percentage of emergency department visits for pain at which an opioid was given or prescribed increased from 37.4% in 2005 to 43.1% in 2010 and then decreased to 30.9% in 2017.

A similar pattern was observed in all four regions. Percentages for the Northeast were lower than for the nation as a whole for all years analyzed.

In 2017, the percentage was 21.1% in the Northeast, compared with 32.0% in the Midwest, 32.0% in the South, and 34.7% in the West.

Source: National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey, 2005–2017. https://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm.


QuickStats: Number of Emergency Department Visits, for Substance Abuse or Dependence per 10,000 Persons Aged 18 Years or Older, by Age Group — United States, 2008–2009 and 2016–2017

December 20, 2019

The rate of emergency department visits with a primary diagnosis or primary complaint of substance abuse or dependence by patients aged 18–34 years in the United States increased from 45.4 visits per 10,000 persons in 2008–2009 to 76.0 visits in 2016–2017 but remained stable among patients aged 35 years or older (27.2 in 2008–2009 and 24.6 in 2016–2017).

In both periods, persons aged 18–34 years were more likely to visit the ED for substance abuse or dependence than those aged 35 years or older.

Source: National Hospital Ambulatory Medical Care Survey, 2008–2017.


Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5–24 Years, 2010–2016

November 15, 2019

Questions for Lead Author Anna Rui, Health Statistician, of “Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5–24 Years, 2010–2016.”

Q: What do you think is the most significant finding in this report?

AR: The top activities that caused emergency room (ER) visits for sports injuries by patients ages 5-24 years were football, basketball, pedal cycling, and soccer. There was wide variation by age and sex in the types of activities causing ER visits for sports injuries.


Q: Out of all of the sports, which sport or activity was found to have the largest increase in ER visits over time?

AR: We did not assess trends over time in the report.


Q: Is it accurate to say that the sports in the study are the most dangerous? Or do they have the most ER visits because they are simply the most popular?

AR: There are likely other health care utilization measures besides ER visits that others would want to look at as well, but the purpose of the report was to estimate the number of ER visits for sports injuries, and these are the sports that account for the most visits.


Q: What are some limitations of the report?

AR: The definition of sports and recreational activities relied on data processing and manual review of medical records, which could have resulted in over- or under-estimation of the sports injury ER rate. The study did not include patients who sought care in other settings or who did not seek care; thus the estimates in the report are an underestimate of all health care utilization for sports injuries.


Q: Why is this report important?

AR: Many young Americans engage in some type of sports or recreational activity each year, and sports and recreation-related injuries are a common type of injury seen in hospital ERs. It’s important to understand the types of injuries that are most commonly seen in the ER and which sports account for those injuries in order to monitor and guide injury prevention efforts. In addition, we provide updated estimates of treatments administered in the ER for sports injuries, which provides new information that can be used to monitor improvements to the quality and value of care and serve as a benchmark for future studies.


Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016

May 31, 2019

Questions for Lead Author Anna Rui, Health Statistician, of “Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016.”

Q: Why did you decide to focus on opioids prescribed at discharge or given during emergency department visits in the United States for this report?

AR:

Prescription opioid abuse and overdose continue to be critical public health issues. Opioid misuse, abuse, and overdose are affected by multiple factors including the number of people exposed. The Emergency Department (ED) is one setting where people could become exposed to opioids. In 2016, 27.5% of adult ED visits included opioids given in the ED, prescribed at ED discharge, or both (data not shown in report). The ED setting is where people frequently receive their first opioid treatment, after which patients with moderate to severe pain are often sent home with a prescription for an opioid, leaving them with the option of filling/not filling the prescription, or diverting filled prescriptions.

In the National Hospital Ambulatory Medical Care Survey (NHAMCS), information is collected on whether drugs are given during the ED visit, prescribed at discharge, or both.  However, in our published reports, the focus is on estimates of drugs and visits with drugs rather than how they are administered.  I wanted to assess visits with opioids prescribed at discharge separately to see how they compared with those given in the ED, in order to glean new information that has not previously been reported.  This could hopefully provide additional insight into patient populations visiting the ED who are exposed to opioids.


Q: How do rates of visits with opioids only given in the ED compare with opioids only prescribed at discharge and visits with both given and prescribed opioids?

AR: Generally, the rate of ED visits with opioids given during the visit was higher than the rate of ED visits with opioids prescribed at discharge.  Compared with the rate of ED visits with opioids prescribed at discharge, the rate where opioids were only given in the ED was higher among patients aged 45 and over and for both women and men.  Adults aged 18-44 were more likely to receive a prescription for an opioid at discharge compared with adults 45 and over.


Q: How did the data vary by emergency department visits where opioids were given, prescribed or both by primary diagnosis?

AR: The type of opioid administration among ED visits where opioids were given, prescribed, or both varied for certain selected diagnoses. For visits with a primary diagnosis of injury or trauma with opioids given or prescribed, the percentage with opioids only prescribed at discharge (40.7%) was higher than both the percentage of visits with opioids only given at the ED visit (26.3%) and visits with opioids both given and prescribed at discharge (32.7). Conversely, at visits for chest pain and abdominal pain with opioids given and/or prescribed, a higher percentage of opioids were only given at the ED visit. There was no variation across the types of opioid administration for back pain and extremity pain.


Q: Was there a specific finding in your report that surprised you?

AR:I was surprised at the high percentages of visits with opioids prescribed at discharge compared with those only given in the ED for certain diagnoses.  For example, among visits with a primary diagnosis of injury or trauma and where opioids were given or prescribed, a total of 73.4% included an opioid prescription at discharge.  Among visits primarily for extremity pain and where opioids were given or prescribed, 67.9% included an opioid prescription at discharge. Finally, among visits primarily for back pain in which opioids were given or prescribed, 64.5% included an opioid prescription at discharge. However I should also note that these estimates are based only on visits where the patient got opioids during the visit or at discharge.  For example, there are other ED visits made for injury where the patient did not get opioids at all, but we did not assess this in the report.


Q: Do you foresee the number of prescription opioids at emergency department visits increasing in the future?

AR: We do not make predictions about future data trends, but other research published by CDC for recent years showed stable or declining trends in the percentage of visits with opioids given in the ED, prescribed at discharge, or both.


QuickStats: Percentage of Emergency Department Visits Made by Patients with Chronic Kidney Disease Among Persons Aged 18 Years or Older, by Race/Ethnicity and Sex

January 11, 2019

During 2015–2016, 3.5% of adult visits to the emergency department were made by those with chronic kidney disease.

A higher percentage of visits were made by men with chronic kidney disease than women (4.1% compared with 2.7%).

The same pattern was observed for non-Hispanic black men (5.0%) and women (2.4%).

Although the pattern was similar, there was no statistically significant difference in emergency department visits by sex for Hispanic and non-Hispanic white adults.

SOURCE: National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 2015–2016.

https://www.cdc.gov/mmwr/volumes/68/wr/mm6801a7.htm


Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014

June 6, 2018

Donald Cherry, M.S., Health Statistician

Questions for Donald Cherry, M.S., Health Statistician, and Lead Author of “Mental Health-related Physician Office Visits by Adults Aged 18 and Over: United States, 2012-2014

Q:  Was there a result in your study that you hadn’t expected and that really surprised you?

DC:  Most of the results confirmed what we’ve seen in current research, so there really was not a finding in this study that surprised me. But confirming existing knowledge is an important finding! Specifically, the results examining urban-rural visit differences are exactly in the expected direction; that is, in large metropolitan areas, psychiatrists are more concentrated (as suggested by prior research), and we would expect to see a higher percentage of visits to them for mental health-related issues. Rural areas have less psychiatrists and more primary care physicians (PCPs) (as suggested by prior research), and seeing 54% of mental health-related visits occurring at primary care physician offices suggests that in these rural areas, availability of provider type for outpatient mental health treatment might be limited.

Also, the results show no difference in a couple of areas. One area where you can see this is in the percent of health-related visits to psychiatrists vs. PCPs when Medicare is the expected source of payment. We see this too, in the rate of visits when the patient age is 65 years and older – which is interesting for its possible implications.  These results together may indicate that older adults, who are also assumed more likely to use Medicare, are as inclined to visit a primary care physician as they are a psychiatrist for mental health-related issues.


Q:  What would you say is the take-home message of this report?

DC:  I think the real take-home message of this report is that continued monitoring of the utilization of mental health services is important in identifying the present and future needs of the U.S. adult population. As one might expect, the composite of mental health-related visits occur in psychiatrists’ offices; however, this does not seem to be a phenomenon that is always consistent. Differences in mental health-related visits by physician specialty did vary by age, payment type, and within patient sex. The most interesting difference is in large metropolitan areas where a higher percentage of mental health-related office visits are to psychiatrists compared to primary care physicians (PCPs). In rural areas, an opposite trend is observed. This is consistent with past research and further suggests that a greater supply of, and access to, primary care physicians vs. psychiatrists occurs in rural areas.


Q:  What made you decide to conduct this study on mental health-related doctor’s office visits?

DC:  My background is in psychology, and I’m very interested in mental health issues, so mental-health related doctor’s office visits is a natural topic for me to explore. Having access to the National Ambulatory Medical Care Survey (NAMCS) data has given me the opportunity to examine different research topics. In the past, I have also been privileged to collaborate with prominent researchers in the field who have used NAMCS data. I have specifically been interested in where people are going to get treatment for mental health issues. Data accessibility in NAMCS is especially useful becauses it collects visit details on both primary care physicians and psychiatrists in the same survey sample design.


Q:  What differences or similarities did you see between or among various demographic groups in this analysis?

DC:  We did note some differences among different age groups, between sexes, and between rural and urban areas of the United States. When examining age, the mental health-related office visit rate to psychiatrists is higher compared with the rate to primary care physicians among all adults, and among adults in age groups 18–34, 35–49, and 50–64. But there was no significant difference among adults aged 65 and over. Not seeing a difference in rates for the oldest patients is interesting, and some researchers indicate that psychiatrists have a proportionately smaller role in office-based mental health care among older adults — than younger — perhaps due to age-related attitudinal differences toward psychiatric services.

Looking at sex, mental health-related office visit rates to psychiatrists are higher compared with primary care physicians for both men and women, but the visit rate is higher for women compared to men (1,380 vs. 1,111 visits per 10,000 adults).  Within-sex differences were expected given the overall premise of where adults as a group are getting their care. Within-sex differences follow 2016 data presented by The National Institutes of Mental Health that show the prevalence of any mental health illness is higher in women (21.7%) vs. men (14.5%).

Large metropolitan areas experienced a higher percentage of mental health-related office visits to psychiatrists compared to PCPs. In rural areas, an opposite trend was observed. This is consistent with past research and further suggests that a greater supply of, and access to, primary care physicians vs. psychiatrists occurs in rural areas. In medium to small metropolitan areas there was no difference in the percent of visits to either physician specialty, suggesting a possible absence of a supply-demand issue.


Q:  What sort of trend data do you have on this topic that will help us see how mental health-related doctor’s office visits have evolved over time?

DC:  Although we did not examine mental health-related office visits across years for this analysis, we certainly have the ability to examine the same characteristics in future research. An interesting finding in our current report is that mental health-related office visit rates to psychiatrists are higher compared with primary care physician visit rates in all age groups — except for adults aged 65 and over, and as a percentage of visits among all primary expected payment types except Medicare. These results together may indicate that older adults, who are assumed more likely to use Medicare, are as inclined to visit a primary care physician as they are a psychiatrist for mental health-related issues.


Q:  What information do you have on the differences between or among the different types of physicians that are visited for mental health, e.g. what do patients get at a psychiatrist’s office visit that they may not receive at a primary care physician’s – and vice versa?

DC:  There is information available about the type of care patients receive for mental health from different types of physicians. We do have the ability to determine some components of care which patients receive at mental health-related visits; for example, did the patient receive psychotherapy, health education/counseling, psychotropic medications, etc. However, this topic has been examined before as researchers outside The National Center for Health Statistics (NCHS) have studied care received at psychiatrist vs. PCP offices, so this data brief did not explore these factors extensively. Perhaps in a future NCHS study! The uniqueness of this research in how we define a mental health-related office visit should be recognized – and will be very useful in future studies. By using the patient’s reason for a visit, and not a physician’s diagnosis, we attempt to control that at least the initial reason for the visit was for a mental health issue.