Changes in Emergency Department Visit and Hospitalization Rates Across 88 Illinois Community Areas Associated with Health Insurance Change During Implementation of the Affordable Care Act, 2010-2014

Emergency Departments (EDs) are now coping with the effects of delivery system change implementation of the Affordable Care Act (ACA) legislation. The ACA promises to achieve greater access to care for millions of previously uninsured Americans. The proposed study will evaluate 2010-2014 ED visits and hospitalization rates through the ED, for the age 18-64 population in Illinois, who experienced the greatest changes in insurance status over the last four years. However, even before ACA Medicaid and insurance exchange expansions, many states including Illinois have witnessed new approaches to care coordination. These initiatives by public and private sector health systems include accountable care contracts, capitation, readmissions penalties, and delivery system re-design around the country. We propose to examine changes in both outpatient ED visits and hospitalizations through the ED by patients’ insurance status. In addition, we repose to examine trends in ED visits and ED admission rates for ambulatory care sensitive conditions (ACSCs), as defined by the US Agency for Healthcare Research and Quality (AHRQ) as part of their publicly available Prevention Quality Indicators (PQIs). Study findings will provide a valuable index of changes in ED hospital utilization in Illinois across the five year study period as delivery system changes evolved in response to public and private care management initiatives. The overall objective of this study is to examine changes in both outpatient ED visits and hospitalizations through the ED by patients’ insurance status. Successful completion of this study will provide insights into current controversies about the extent to which increased access to care increases (or ultimately decreases) ED visits and ED hospitalizations.