Emergency department revisits for @entity1 with XXXX in California.

@entity1 @entity1290 @entity341
OBJECTIVES: @entity1290 affect nearly one in 11 @entity1 in the United States, and among those experiencing symptoms, emergency care is common. In this population, little is known about the incidence of and factors associated with repeat @entity341 ( @entity341 ) visits. The objective was to identify associations between potentially mutable factors and the risk of an @entity341 revisit for @entity1 with @entity1290 in a large, all-payer cohort. METHODS: This was a retrospective cohort study of all @entity1 in California initially treated and released from EDs for @entity1290 between February 2008 and November 2009. A multivariable regression model was created to identify associations between @entity1 -level characteristics, area health care resources, processes of care, and the risk of repeat @entity341 visits. The primary outcome was a second @entity341 visit within 30 days of the initial discharge from emergent care. RESULTS: Among 128,564 @entity1 discharged from emergent care, 13,684 (11%) had at least one additional emergent visit for treatment of their @entity1290 . In these @entity1 , nearly one in three required hospitalization or an urgent temporizing procedure at the second visit. On multivariable analysis, the risk of an @entity341 revisit was associated with insurance status (e.g., Medicaid vs. private insurance; odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.43 to 1.61; p < 0.001). Greater access to urologic care was associated with lower odds of an @entity341 revisit (highest quartile OR = 0.88, 95% CI = 0.80 to 0.97; p < 0.01 vs. lowest quartile). In exploratory models, performance of a complete blood count was associated with a decreased odds of revisit (OR = 0.86, 95% CI = 0.75 to 0.97; p = 0.02). CONCLUSIONS: Repeat high-acuity care affects one in nine @entity1 discharged from initial emergent evaluations for @entity1290 . Access to urologic care and processes of care are associated with lower risk of repeat emergent encounters. Efforts are indicated to identify preventable causes of @entity341 revisits for @entity1290 @entity1 and design interventions to reduce the risk of high-cost, high-acuity, repeat care.
