Emergency Department Visits by Homeless Status and Sex: United States, 2016-2021.

Objectives-This report describes emergency department (ED) visits by homeless status and sex. Methods-Nationally representative estimates were calculated from data collected in the 2016-2021 National Hospital Ambulatory Medical Care Survey, an annual national probability sample survey of ED visits in the United States. Visits by people experiencing homelessness were defined using data on patient residence from medical records. Visits by males and females experiencing homelessness are compared with each other and with visits by males and females not experiencing homelessness. Results-During 2016-2021, approximately 981,000 and 460,000 ED visits were made annually by males and females experiencing homelessness, respectively. Significant differences by sex were found for this population for many ED visit characteristics, including arrival by ambulance, diagnoses, and chronic conditions. ED visits by males and females experiencing homelessness also differed significantly from ED visits by males and females not experiencing homelessness based on age, geographic region, expected source of payment, primary diagnosis, chronic conditions, and other characteristics. Conclusion-This report highlights certain differences by sex among the population experiencing homelessness who visited the ED and compares them with people who visited the ED but were not experiencing homelessness.

Trends in Emergency Department Visits Among People Younger Than Age 65 by Insurance Status: United States, 2010-2021.

Purpose-This report describes trends in emergency department visits among people younger than age 65 from 2010 through 2021, by health insurance status and selected demographic and hospital characteristics. Methods-Estimates in this report are based on data collected in the 2010-2021 National Hospital Ambulatory Medical Care Survey. Data were weighted to produce annual national estimates. Patient and hospital characteristics are presented by primary expected source of payment. Results-Private insurance and Medicaid were the most common primary expected sources of payment at emergency department visits by people younger than age 65 from 2010 through 2013. Medicaid was the most common primary expected source of payment from 2014 through 2021. Among children younger than age 18 years, the most common primary expected source of payment was Medicaid across the entire period. The percentage of visits by children with no insurance decreased from 7.4% in 2010 to 3.0% in 2021. Among adults, the percentage of visits with Medicaid increased from 25.5% in 2010 to 38.9% in 2021, and the percentage of visits by those with no insurance decreased from 24.6% to 11.1% during this period. Among Black non-Hispanic and Hispanic people, Medicaid was the most frequent primary expected source of payment during the entire period. Among White non-Hispanic people, private insurance was the most frequent primary expected source of payment through 2015, while private insurance and Medicaid were the most frequent primary expected sources of payment from 2016 through 2021.

Opioids Prescribed to Adults at Discharge From Emergency Departments: United States, 2017-2020.

Opioids may be an effective treatment for chronic and acute pain when properly used (1). However, receiving an opioid prescription in the emergency department (ED) has been identified as a potential risk factor for long-term use (2). Between 2010-2011 and 2016-2017, the percentage of opioids prescribed at ED discharge decreased from 21.5% to 14.6% (3,4). This report provides more recent changes in rates and percentages of opioids prescribed to adults (aged 18 and over) at discharge from the ED by patient and visit characteristics through 2020, using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS).

Emergency Department Visit Rates by Adults With Diabetes: United States, 2020-2021.

In 2021, diabetes was the eighth leading cause of death in the United States (1). Over 37 million Americans have diabetes (2). While it most often develops in people older than age 45 (3), its frequency is increasing in young adults (4). Among people with diabetes, increasing age is a risk factor for hospitalization (5). Emergency department (ED) visits by people with diabetes have been used to monitor access to care and healthcare use (6). This report describes ED visits made by adults with diabetes, and presents selected characteristics by age.

Characteristics of Visits to Health Centers: United States, 2020.

Health centers provide comprehensive medical care in medically underserved communities (1). The number of health centers has expanded in the last decade from 1,124 sites in 2010 to 1,375 sites in 2020 (2,3). In 2020, nearly 29 million people received medical care from health centers regardless of their insurance status or ability to pay for care (3). This report examines health center visit rates by various characteristics, like age, sex, insurance status, reason for visit, and services, using data from the 2020 National Ambulatory Medical Care Survey-Community Health Centers (NAMCS-CHC).

Emergency Department Visits for Influenza and Pneumonia: United States, 2016-2018.

In the United States, there were an estimated 810,000 hospitalizations attributable to influenza during 2017-2018 (1). Pneumonia is the most common respiratory complication of influenza (2). In 2019, the ninth leading cause of death was influenza and pneumonia and the death rate was 15.2 per 100,000 persons, ranging from 4.1 for infants aged under 1 year to 294.7 for adults aged 85 and over (3,4). This report describes emergency department (ED) visit rates for patients with influenza and pneumonia (either influenza or pneumonia, or both) by selected patient characteristics.

Trends in Office Visits During Which Opioids Were Prescribed for Adults With Arthritis in the US, 2006-2015.

OBJECTIVE: To analyze trends for visits to office-based physicians at which opioids were prescribed among adults with arthritis in the US, from 2006 to 2015. METHODS: We analyzed nationally representative data on patient visits to office-based physicians from 2006 to 2015 from the National Ambulatory Medical Care Survey (NAMCS). Visit percentages for first- and any-listed diagnosis of arthritis by age groups and sex were reported. Time points were grouped into 2-year intervals to increase the reliability of estimates. Annual percentage point change and 95% confidence intervals (95% CIs) were reported from linear regression models. RESULTS: From 2006 to 2015, the percentage of visits to office-based physicians by adults with a first-listed diagnosis of arthritis increased from 4.1% (95% CI 3.5%, 4.7%) in 2006-2007 to 5.1% (95% CI 3.9%, 6.6%) in 2014-2015 (P = 0.033). Among these visits, the percentage of visits with opioids prescribed increased from 16.5% (95% CI 13.1%, 20.5%) in 2006-2007 to 25.6% (95% CI 17.9%, 34.6%) in 2014-2015 (P = 0.017). The percentage of visits with any-listed diagnosis of arthritis increased from 6.6% (95% CI 5.9%, 7.4%) in 2006-2007 to 8.4% (95% CI 7.0%, 10.0%) in 2014-2015 (P = 0.001). Among these visits, the percentage of visits with opioids prescribed increased from 17.4% (95% CI 14.6%, 20.4%) in 2006-2007 to 25.0% (95% CI 19.7%, 30.8%) in 2014-2015 (P = 0.004). CONCLUSION: From 2006 to 2015, the percentage of visits to office-based physicians by adults with arthritis increased and the percentage of opioids prescribed at these visits also increased. NAMCS data will allow continued monitoring of these trends after the implementation of the 2016 Centers for Disease Control and Prevention Guideline for prescribing opioids for chronic pain.

Emergency Department Visits Among Adults Aged 60 and Over: United States, 2014-2017.

In the United States, the number of older adults is increasing. From 2007 to 2017, the number of adults aged 60 and over increased from 52 million to 71 million, and during the same time period, the share of the U.S. population comprising older adults also increased from 17% to 22% (1,2). During 2014-2017, 20% of all emergency department (ED) visits in the United States were made by patients aged 60 and over, representing an annual average of approximately 29 million ED visits (3-6). Given their growing proportion of the population, older individuals will make up an increasingly larger share of ED visits in the coming years. This report describes ED visits made by adults aged 60 and over, assessing selected characteristics by age.

Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016.

Opioid analgesics are primarily used to treat chronic and acute pain and, when used appropriately, can be an important part of treatment (1). Pain is a major symptom of patients visiting the emergency department (ED), with up to 42% of ED visits being related to pain (2). Opioids may either be administered in the ED as part of treatment, provided post-treatment in the form of a prescription, or both (3). This report compares rates and percentages of ED visits by adults at which opioids were only given in the ED, only prescribed at discharge, or both, by selected characteristics.

Characteristics of Visits to Primary Care Physicians by Adults Diagnosed With Hypertension.

Objective-This report describes the demographic, state, and regional differences in hypertension control and pharmaceutical treatment among visits to primary care physicians made by hypertensive adults during 2013-2014. Methods-Data are from the 2013-2014 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of visits to nonfederal, office-based physicians. The sample design for the 2013-2014 NAMCS included oversampling in selected states. Estimates are provided for the 18 states oversampled in both years. Estimates are also presented for the nine census divisions. The study population includes all primary care physician visits made by nonpregnant adults who have hypertension, as defined by documentation of hypertension in their medical record. Hypertensive visits indicating hypertension control as well as those with mention of a hypertensive medication were examined by selected demographic characteristics as well as by region and state. Sample weights were applied to each case to provide national estimates of health care utilization. Results-During 2013-2014, in the United States, hypertension control was indicated [a blood pressure (BP) measurement of less than 140/90 mm Hg] at an estimated 66.0% of hypertensive visits. There was mention of at least one hypertensive medication documented in the medical record at 72.0% of hypertensive visits. Hypertension control was indicated at a lower percentage of hypertensive visits made by non-Hispanic black persons (57.4%) than hypertensive visits made by all other racial or ethnic groups. Hypertension was under control or there was mention of a hypertensive medication at a lower percentage of hypertensive visits made by adults aged 18-44 than hypertensive visits by older adults. The percentage of visits with an indication of hypertension control varied widely by state (ranging from 53.7% in Tennessee to 73.2% in Florida) and region (ranging from 60.1% in the East South Central division to 71.1% in the New England division). Among the 18 states, the percentage of hypertensive visits that had mention of a hypertensive medication ranged from 57.1% in Georgia to 85.0% in Washington. Conclusion- The demographic and geographical differences identified in this report may help inform state and local policies aimed at controlling hypertension.

Age Differences in Visits to Office-based Physicians by Adults With Hypertension: United States, 2013.

KEY FINDINGS: Data from the National Ambulatory Medical Care Survey •The percentage of all adult visits to office-based physicians made by adults with hypertension increased with age, from 9% for those aged 18-44 to 58% for those aged 75 and over. •Hypertensive medications were provided, prescribed, or continued at 62% of visits made by adults with hypertension. •Eighty-two percent of visits by adults with hypertension were made by those with multiple chronic conditions, and the number of chronic conditions increased with age. •Diseases of the circulatory system increased as age increased, from 23% for those aged 18-44 to 29% for those aged 75 and over. Hypertension is a chronic condition that affects 31% of adults in the United States (1). The prevalence of hypertension increases with age, from 7% among those aged 18-39 to 65% among those aged 60 and over (2). This report describes age differences for chronic conditions mentioned, hypertensive medications prescribed, doctor visits in the past year, and selected primary diagnoses for office-based physician visits made by adults with hypertension. Adults with hypertension were defined as those aged 18 and over who have been diagnosed with hypertension, regardless of the diagnosis for the current visit. In 2013, there were 258.5 million visits made by such patients, representing 34% of all office-based physician visits by adults (3).

A Note on the Effect of Data Clustering on the Multiple-Imputation Variance Estimator: A Theoretical Addendum to , JOS.

Multiple imputation is a popular approach to handling missing data. Although it was originally motivated by survey nonresponse problems, it has been readily applied to other data settings. However, its general behavior still remains unclear when applied to survey data with complex sample designs, including clustering. Recently, Lewis et al. (2014) compared single- and multiple-imputation analyses for certain incomplete variables in the 2008 National Ambulatory Medicare Care Survey, which has a nationally representative, multistage, and clustered sampling design. Their study results suggested that the increase of the variance estimate due to multiple imputation compared with single imputation largely disappears for estimates with large design effects. We complement their empirical research by providing some theoretical reasoning. We consider data sampled from an equally weighted, single-stage cluster design and characterize the process using a balanced, one-way normal random-effects model. Assuming that the missingness is completely at random, we derive analytic expressions for the within- and between-multiple-imputation variance estimators for the mean estimator, and thus conveniently reveal the impact of design effects on these variance estimators. We propose approximations for the fraction of missing information in clustered samples, extending previous results for simple random samples. We discuss some generalizations of this research and its practical implications for data release by statistical agencies.

Prevalence of incontinence among older americans.

Objective - This report presents national estimates of incontinence prevalence in the United States using data source-specific definitions of incontinence among persons aged 65 and over by sociodemographic characteristics during 2007-2010. Methods - Data are from the 2007-2010 National Health and Nutrition Examination Survey (NHANES), the 2010 National Survey of Residential Care Facilities (NSRCF), the 2007 National Home and Hospice Care Survey (NHHCS), and the 2009 Long Term Care Minimum Data Set (MDS). Findings are based on in-home interviews with 2,625 noninstitutionalized respondents (NHANES) and reports provided by designated facility or agency staff members for 6,856 residential care facility (RCF) residents (NSRCF), 3,226 current home health care patients (NHHCS), 3,918 hospice discharges (NHHCS), and 2,416,705 nursing home residents (MDS). Response rates for incontinence questions were 84% among noninstitutionalized persons (NHANES), 98% among RCF residents and home health and hospice care patients (NSRCF and NHHCS), and 99% for nursing home residents (MDS). Results - This is the first report presenting national estimates on incontinence for subpopulations of older persons sampled in the Centers for Disease Control and Prevention's National Center for Health Statistics surveys and the Centers for Medicare and Medicaid Services' Long Term Care Minimum Data Set. Because a different definition of incontinence is used by each data collection system, it is not possible to make data comparisons between them or to summarize results across all surveys. Accordingly, only survey-specific results are presented. Including recent data from all of these data collection systems facilitates a multidimensional picture of incontinence, while underscoring the need for a standardized definition.

Generalist and specialty physicians: supply and access, 2009-2010.

As the overall population ages, policy makers are focusing on the current and growing shortage of the primary care workforce (1­3), particularly as provisions of the 2010 Patient Protection and Affordable Care Act (PPACA) expand health insurance coverage. This report presents selected trends in physician shortage measures and access to care measures for generalist physicians and specialists. Generalists are those in the specialties of family practice, general practice, internal medicine, and pediatrics, whereas specialists comprise all other specialties. Estimates are based on physicians who participated in the National Ambulatory Medical Care Survey (NAMCS) by providing data on visits.

Availability of pediatric services and equipment in emergency departments: United States, 2006.

OBJECTIVES: This report presents data on the availability of pediatric services, expertise, and supplies for treating pediatric emergencies in U.S. hospitals. METHODS: Data in this report are from the Emergency Pediatric Services and Equipment Supplement (EPSES), a self-administered questionnaire added to the 2006 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS samples nonfederal short-stay and general hospitals in the United States. Sample data were weighted to produce annual estimates of pediatric services, expertise, and equipment availability in hospital emergency departments (EDs). RESULTS: In 2006, only 7.2 percent of hospital EDs had all recommended pediatric emergency supplies, and 45.6 percent had at least 85.0 percent of recommended supplies. EDs in children's hospitals and hospitals with pediatric intensive care units (PICUs) were more likely to meet guidelines for pediatric emergency department services, expertise, and supplies. About 74.0 percent of these facilities had at least 85.0 percent of recommended supplies, compared with 42.4 percent of other facilities. Among children's hospitals and hospitals with PICUs, 66.0 percent had 24 hours a day, 7 days a week access to a board-certified pediatric emergency medicine attending physician; such access was uncommon in other types of hospitals. In general, little change was noted in the availability of emergency pediatric supplies between 2002-2003, when the initial EPSES was conducted, and 2006.

Emergency department volume and racial and ethnic differences in waiting times in the United States.

BACKGROUND: Racial and ethnic differences in emergency department (ED) waiting times have been observed previously. OBJECTIVES: We explored how adjusting for ED attributes, particularly visit volume, affected racial/ethnic differences in waiting time. RESEARCH DESIGN: We constructed linear models using generalized estimating equations with 2007-2008 National Hospital Ambulatory Medical Care Survey data. SUBJECTS: We analyzed data from 54,819 visits to 431 US EDs. MEASURES: Our dependent variable was waiting time, measured from arrival to time seen by physician, and was log transformed because it was skewed. Primary independent variables were individual race/ethnicity (Hispanic and non-Hispanic white, black, other) and ED race/ethnicity composition (covariates for percentages of Hispanics, blacks, and others). Covariates included patient age, triage assessment, arrival by ambulance, payment source, volume, region, and teaching hospital. RESULTS: Geometric mean waiting times were 27.3, 37.7, and 32.7 minutes for visits by white, black, and Hispanic patients. Patients waited significantly longer at EDs serving higher percentages of black patients; per 25 point increase in percent black patients served, waiting times increased by 23% (unadjusted) and 13% (adjusted). Within EDs, black patients waited 9% (unadjusted) and 4% (adjusted) longer than whites. The ED attribute most strongly associated with waiting times was visit volume. Waiting times were about half as long at low-volume compared with high-volume EDs (P<0.001). For Hispanic patients, differences were smaller and less robust to model choice. CONCLUSIONS: Non-Hispanic black patients wait longer for ED care than whites primarily because of where they receive that care. ED volume may explain some across-ED differences.

Ambulatory medical care utilization estimates for 2007.

OBJECTIVES: This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments (OPDs), and hospital emergency departments (EDs) in the United States in 2007. Ambulatory medical care utilization is described in terms of patient, provider, and visit characteristics. METHODS: Data from the 2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were combined to produce annual estimates of ambulatory medical care utilization. RESULTS: Patients in the United States made an estimated 1.2 billion visits to physician offices and hospital OPDs and EDs, a rate of 405.0 visits per 100 persons annually. This was not significantly different than the rate of 381.9 visits per 100 persons in 2006, neither were significant differences found in overall visit rates by age, sex, or geographic region. Visit distribution by ambulatory care setting differed by poverty level in the patient's ZIP Code of residence, with higher proportions of visits to hospital OPDs and EDs as poverty levels increased. Between 1997 and 2007, the age-adjusted visit rate increased by 11 percent, fueled mainly by a 29 percent increase in the visit rate to medical specialty offices. Nonillness and noninjury conditions, such as general and prenatal exams, accounted for the largest percentage of ambulatory care diagnoses in 2007, about 19 per 100 visits. Seven of 10 ambulatory care visits had at least one medication provided, prescribed, or continued in 2007, for a total of 2.7 billion drugs overall. These were not significantly different than 2006 figures. Analgesics were the most common therapeutic category, accounting for 13.1 drugs per 100 drugs reported, and were most often utilized at primary care and ED visits. The number of viral vaccines that were ordered or provided increased by 79 percent, from 33.2 million occurrences in 2006 to 59.3 million in 2007; significant increases were also noted for anticonvulsants and antiemetics.