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Table 1 Characteristics of adult emergency department (ED) users in Texas Medicaid, CY 2014

From: Variation in outpatient emergency department utilization in Texas Medicaid: a state-level framework for finding “superutilizers”

 

Number of ED visits

   

Range of potential overutilization

       

EFa

0

1

2

3–4

5–6

7–9

10–14

15+

All

Number of patients

773,001

176,198

75,955

57,435

19,132

9970

4877

3084

1,119,652

Percent of patients

69.04

15.74

6.78

5.13

1.71

0.89

0.44

0.28

100.00

Percent of ED visits

0.00

21.25

18.32

23.23

12.42

9.32

6.75

8.71

100.00

Cumulative percentage of ED visits

0.00

50.83

72.74

89.31

94.83

97.70

99.11

100.00

NA

Medical expenditureb

 Percent of total medical expenditure

40.72

20.58

12.28

12.31

5.48

3.66

2.39

2.57

100.00

 Average medical expenditure per patient

$2145

$4758

$6582

$8731

$11,673

$14,945

$19,968

$33,989

$3637

ED expenditurec

 Percent of total ED expenditure

NA

20.38

17.56

22.83

12.29

9.56

7.12

10.25

100.00

 Average ED expenditure per patient

NA

$374

$747

$1285

$2076

$3101

$4722

$10,750

$289

 Average ED expenditure per visit

NA

$369

$368

$377

$379

$392

$400

$433

$382

Inpatient (IP) stays

 Average IP stays

0.23

0.37

0.45

0.57

0.77

0.97

1.38

2.35

0.31

 Percent of total IP stays

51.04

18.53

9.91

9.47

4.23

2.79

1.94

2.08

100.00

 Percent of total IP expenditurec

43.74

19.80

11.61

11.61

5.13

3.50

2.31

2.30

100.00

 Average IP expenditure per patientc

$830

$1649

$2243

$2967

$3932

$5159

$6938

$10,969

$1311

 Average IP expenditure per stayc

$3560

$4413

$4820

$5035

$4859

$5102

$4847

$4553

$4130

Program visit distributiond (%)

 Fee-for-service (FFS)

NA

32.75

28.58

24.23

20.94

19.19

18.15

19.08

25.07

 In managed care

NA

67.25

71.42

75.77

79.06

80.81

81.85

80.92

74.94

Sociodemographic characteristics

 Mean age (years)e

30.89

32.64

33.14

33.79

34.73

35.88

37.28

38.94

31.63

 Percent female

78.18

77.82

79.21

79.67

79.10

77.60

74.98

67.48

78.23

 Race or ethnicity (%)

  Black

18.68

21.39

23.67

25.26

26.4

26.25

24.48

23.44

20.02

  Hispanic

46.26

41.75

37.65

33.82

29.19

27.40

24.50

25.23

43.72

  White

23.55

25.63

27.15

28.5

30.27

31.18

32.93

32.3

24.62

  Other or unknown

11.51

11.22

11.53

12.41

14.15

15.16

18.09

19.03

11.64

 Poverty indexf

22.86

23.50

23.53

23.44

23.26

23.78

23.53

24.25

23.06

 High-density population

81.76

80.76

80.80

80.74

81.36

81.52

82.20

82.60

81.48

Disability status (%)

 Disabled eligibility

23.04

32.20

36.12

40.82

47.67

54.62

62.91

75.45

27.30

History of chronic conditionsg

 Any chronic condition (%)

26.42

45.42

53.49

62.17

71.98

79.31

86.45

93.87

34.78

 Multiple chronic conditions (%)

13.48

26.07

32.5

39.83

49.72

58.95

69.57

83.53

19.56

 Substance use disordersh (%)

13.85

31.82

41.57

50.72

61.37

69.25

78.55

85.41

22.23

 Mental illnessh (%)

22.88

39.83

49.12

58.54

70.20

78.15

86.22

90.08

30.92

 Schizophreniah (%)

2.98

5.38

7.03

9.23

13.32

16.99

22.06

29.31

4.41

 Bipolar disorderh (%)

4.76

10.45

14.44

19.20

27.40

33.85

40.78

49.29

7.98

 Depressive psychosish (%)

5.33

10.81

14.43

18.54

25.03

30.18

36.19

46.24

8.29

 Number of chronic conditions

0.66

1.14

1.42

1.77

2.23

2.66

3.25

4.27

0.93

 Charlson Comorbidity Indexi

0.63

1.24

1.55

1.93

2.42

2.90

3.57

4.94

0.93

  1. Authors’ analysis of Texas Medicaid claims, encounter, and enrollment data. This analysis excludes dual-eligible enrollees
  2. NA not applicable
  3. aExtremely frequent (EF) ED users
  4. bIncludes professional and institutional expenditures. Excludes pharmacy expenditures
  5. cIncludes institutional expenditures
  6. dThe percentage of managed care calculated is based on enrollment (e.g. if a patient has two ED visits and one occurs while enrolled in FFS and the other in managed care, one visit is counted as FFS and the other as managed care)
  7. eAge inclusion 18–62 years old
  8. fThe average percentage of people living in poverty in the enrollees’ census tract (2010 US census data)
  9. gThe history conditions (Chronic conditions, substance use disorder, mental illness, schizophrenia, bipolar disorders, depressive psychosis, and the Charlson Comorbidity Index are identified from 2011 to 2014 diagnosis codes
  10. hThe ICD-9-CM codes used to define chronic conditions, SUD, mental illness, schizophrenia, bipolar disorder, and depressive psychosis were provided by Billings and Raven [7]
  11. iThe weighted version of the Charlson Comorbidity Index is used here. The range of index is 0–33