Factors Affecting Visits to the Emergency Department for Urgent and Nonurgent Ocular Conditions

Abstract

Purpose: To determine the frequency of emergency department (ED) visits for nonurgent and urgent ocular conditions and risk factors associated with ED use for nonurgent and urgent ocular problems.

Design: Retrospective, longitudinal cohort analysis.

Participants: All enrollees aged 21 years or older in a United States managed care network during 2001-2014.

Methods: We identified all enrollees visiting an ED for ocular conditions identified by International Classification of Diseases, billing codes. Diagnosis is well-described as urgent, nonurgent, or other. We assessed the frequency of ED visits for urgent and nonurgent ocular conditions and how they changed over time. Next, we performed multivariable Cox regression modeling to determine factors associated with visiting an ED for urgent or nonurgent ocular conditions.

Main outcome measures: Hazard ratios (HRs) with 95% confidence intervals (CIs) of visiting an ED for urgent or nonurgent ocular conditions.

Results: Of the 11 160 833 enrollees eligible for this study, 376 680 (3.4%) had 1 or more ED visit for an eye-related problem over a mean ± standard deviation of 5.4±3.3 years' follow-up. Among these enrolled, 86 473 (23.0%) had 1 or more ED visits with a nonurgent ocular condition and 25 289 (6.7%) had at least 1 ED visit with an urgent ocular condition. Use of the ED for nonurgent ocular problems was associated with younger age (P < 0.0001 for all comparisons), black race or Latino ethnicity (P < 0.0001 for both), male sex (P < 0.0001), lower income (P < 0.0001 for all comparisons), and those who frequently sought treatment at an ED for nonophthalmologic medical problems in a given year (P < 0.0001). Enrollees with established eye care professionals had a 10% reduced hazard of visiting the ED for nonurgent ocular conditions (adjusted HR, 0.90; 95% CI, 0.88-0.92; P < 0.0001).

Conclusions: Nearly one-quarter of enrollees who visited the ED for an ocular problem received a diagnosis of a nonurgent condition. Better educating and incentivizing patients to seek care for nonurgent ocular diseases in an office-based setting could yield considerable cost savings without adversely affecting health outcomes and could allow EDs to better serve patients with more severe conditions.

Figure 1. Emergency Department Visits for Urgent, Non-Urgent, and Other Ocular Conditions

Distribution of eligible enrollees into those with Emergency Department (ED) visits for urgent, non-urgent, and other ocular conditions. Some enrollees had more than one visit and for different types of ocular conditions. Therefore, the total number of enrollees who had a visit to the ED for any ocular condition is less than the sum of those who had visits for urgent, non-urgent, and other ocular conditions.

Figure 2. Frequency of Visits to the Emergency Department Each Year From 2001-2014

For each year from 2001 to 2014, the figure shows the total number of enrollees visiting the emergency department (ED) for any type of ocular condition per 10,000 enrollees and the total number of enrollees visiting the ED for urgent and non-urgent ocular conditions per 10,000 enrollees.

Figure 3. Factors Associated with Visiting an Emergency Department for Any Ocular Condition

Multivariable Cox regression model identifying factors associated with visiting an emergency department for any ocular condition. Reference groups: age 21-30, white race, male sex, annual income <$40,000. A frequent ED visitor was defined as having > 4 visits / year for non-ophthalmologic conditions. Having a regular eye care provider was defined as >3 visits with an eye care provider with at least one 6-month interval between the visits. The multivariable Cox regression model was also adjusted for education level, urban/rural status, plan type, and dual enrolment status. ED = emergency department.

Figure 4. Factors Associated with Visiting an Emergency Department for a Non-Urgent Ocular Condition

Multivariable Cox regression model identifying factors associated with visiting an emergency department for non-urgent ocular conditions. Reference groups: age 21-30, white race, male sex, annual income <$40,000. A frequent ED visitor was defined as having > 4 visits / year for non-ophthalmologic conditions. Having a regular eye care provider was defined as >3 visits with an eye care provider with at least one 6-month interval between the visits. The multivariable Cox regression model was also adjusted for education level, urban/rural status, plan type, and dual enrolment status. ED = emergency department.

Figure 5. Factors Associated with Visiting an Emergency Department for an Urgent Ocular Condition

Multivariable Cox regression model identifying factors associated with visiting an emergency department for urgent ocular conditions. Reference groups: age 21-30, white race, male sex, annual income <$40,000. A frequent ED visitor was defined as having > 4 visits / year for non-ophthalmologic conditions. Having a regular eye care provider was defined as >3 visits with an eye care provider with at least one 6-month interval between the visits. The multivariable Cox regression model was also adjusted for education level, urban/rural status, plan type, and dual enrolment status. ED = emergency department.