Patterns of emergency department use for dental and oral health care: implications for dental and medical care coordination

Abstract

Objectives: To describe emergency department (ED) utilization for oral conditions (OCs) focusing on total volume, costs, repeat utilization, small area predictors, and implications for dental and medical care coordination.

Methods: Administrative and demographic data for New Jersey were used to identify users of the ED for OCs and a group of "high users," defined as individuals with four or more ED visits for OCs during 2008-2010. Cost-to-charge ratios were used to estimate costs, and linear regression models applied to zip codes were used to determine strongest predictors of small area variation in ED use for OCs.

Results: ED visits for OC generated $25.5 million in costs during 2008-2010. High users represented 4.2 percent of all users and 21.3 percent of ED visits for OCs. Almost all high users had a diagnosis of "dental disorder not otherwise specified," and tobacco use disorder was the most common comorbid medical condition. Young adults (ages 19-34), non-Hispanic blacks, and the medically uninsured were over-represented among high users. High users routinely spread their use across multiple hospitals (e.g., 40 percent of them visited three or more hospitals). Local dentist supply and ED use for other conditions were significant predictors of zip code-level ED use for OCs.

Conclusions: Coordination of medical and dental treatment might improve health and reduce costs if targeted to high user populations. Health-care delivery reforms, such as accountable care organizations, could provide vehicles for achieving this coordination. Important challenges include fragmentation of ED visits across hospitals, adequacy of dentist supply, and broader reliance on the ED for health problems.

Keywords: accountable care organizations; delivery of health care; dental care delivery; health services accessibility; safety-net providers.