Introduction: Illinois hospitals have experienced a marked decrease in the number of uninsured patients after implementation of the Affordable Care Act (ACA). However, the full impact of health insurance expansion on trauma mortality is still unknown. The objective of this study was to determine the impact of ACA insurance expansion on trauma patients hospitalized in Illinois.

Methods: We performed a retrospective cohort study of 87,001 trauma inpatients from third quarter 2010 through second quarter 2015, which spans the implementation of the ACA in Illinois. We examined the effects of insurance expansion on trauma mortality using multivariable Poisson regression.

Results: There was no significant difference in mortality comparing the post-ACA period to the pre-ACA period incident rate ratio (IRR)=1.05 (95% confidence interval [CI] [0.93-1.17]). However, mortality was significantly higher among the uninsured in the post-ACA period when compared with the pre-ACA uninsured population IRR=1.46 (95% CI [1.14-1.88]).

Conclusion: While the ACA has reduced the number of uninsured trauma patients in Illinois, we found no significant decrease in inpatient trauma mortality. However, the group that remains uninsured after ACA implementation appears to be particularly vulnerable. This group should be studied in order to reduce disparate outcomes after trauma.

Introduction: Seniors represent the fasting growing population in the U.S., accounting for 20.3 million visits to emergency departments (EDs) annually. The ED visit can provide an opportunity for identifying seniors at high risk of falls. We sought to incorporate the Timed Up & Go Test (TUGT), a commonly used falls screening tool, into the ED encounter to identify seniors at high fall risk and prompt interventions through a geriatric nurse liaison (GNL) model.

Methods: Patients aged 65 and older presenting to an urban ED were evaluated by a team of ED nurses trained in care coordination and geriatric assessment skills. They performed fall risk screening with the TUGT. Patients with abnormal TUGT results could then be referred to physical therapy (PT), social work or home health as determined by the GNL.

Results: Gait assessment with the TUGT was performed on 443 elderly patients between 4/1/13 and 5/31/14. A prior fall was reported in 37% of patients in the previous six months. Of those screened with the TUGT, 368 patients experienced a positive result. Interventions for positive results included ED-based PT (n=63, 17.1%), outpatient PT referrals (n=56, 12.2%) and social work consultation (n=162, 44%). 

Conclusion: The ED visit may provide an opportunity for older adults to be screened for fall risk. Our results show ED nurses can conduct the TUGT, a validated and time efficient screen, and place appropriate referrals based on assessment results. Identifying and intervening on high fall risk patients who visit the ED has the potential to improve the trajectory of functional decline in our elderly population.

Introduction: This study analyzes changes in hospital emergency department (ED) visit ratesbefore and after the 2014 Affordable Care Act (ACA) insurance expansions in Illinois. We comparethe association between population insurance status change and ED visit rate change between a24-month (2012-2013) pre-ACA period and a 24-month post-ACA (2014-2015) period across 88socioeconomically diverse areas of Illinois.

Methods: We used annual American Community Survey estimates for 2012-2015 to obtain insurancestatus changes for uninsured, private, Medicaid, and Medicare (disability) populations of 88 IllinoisPublic Use Micro Areas (PUMAs), areas with a mean of about 90,000 age 18-64 residents. Over 12million ED visits to 201 non-federal Illinois hospitals were used to calculate visit rates by residents ofeach PUMA, using population-based mapping weights to allocate visits from zip codes to PUMAs. Wethen estimated n=88 correlations between population insurance-status changes and changes in EDvisit rates per 1,000 residents comparing the two years before and after ACA implementation.

Results: The baseline PUMA uninsurance rate ranged from 6.7% to 41.1% and there was 4.6-fold variation in baseline PUMA ED visit rates. The top quartile of PUMAs had >21,000 reductionsin uninsured residents; 16 PUMAs had at least a 15,000 person increase in Medicaid enrollment.Compared to 2012-2013, 2014-2015 average monthly ED visits by the uninsured dropped 42%,but increased 42% for Medicaid and 10% for the privately insured. Areas with the largest increasesin Medicaid enrollment experienced the largest growth in ED use; change in Medicaid enrollmentwas the only significant correlate of area change in total ED visits and explained a third of variationacross the 88 PUMAs.

Conclusion: ACA implementation in Illinois accelerated existing trends towards greater use of hospitalED care. It remains to be seen whether providing better access to primary and preventive care tothe formerly uninsured will reduce ED use over time, or whether ACA insurance expansion is a partof continued, long-term growth. Monitoring ED use at the local level is critical to the success of newhome- and community-based care coordination initiatives. [West J Emerg Med. 2017;18(5)811-820.]

Introduction: Emergency department (ED) patients’ Internet search terms prior to arrival have notbeen well characterized. The objective of this analysis was to characterize the Internet search termspatients used prior to ED arrival and their relationship to final diagnoses.

Methods: We collected data via survey; participants listed Internet search terms used. Terms wereclassified into categories: symptom, specific diagnosis, treatment options, anatomy questions,processes of care/physicians, or “other.” We categorized each discharge diagnosis as either symptombasedor formal diagnosis. The relationship between the search term and final diagnosis was assignedto one of four categories of search/diagnosis combinations (symptom search/symptom diagnosis,symptom search/formal diagnosis, diagnosis search/symptom diagnosis, diagnosis search/formaldiagnosis), representing different “trajectories.”

Results: We approached 889 patients; 723 (81.3%) participated. Of these, 177 (24.5%) used theInternet prior to ED presentation; however, seven had incomplete data (N=170). Mean age was 47years (standard deviation 18.2); 58.6% were female and 65.7% white. We found that 61.7% searchedsymptoms and 40.6% searched a specific diagnosis. Most patients received discharge diagnoses ofequal specificity as their search terms (34% flat trajectory-symptoms and 34% flat trajectory-diagnosis).Ten percent searched for a diagnosis by name but received a symptom-based discharge diagnosiswith less specificity. In contrast, 22% searched for a symptom and received a detailed diagnosis.Among those who searched for a diagnosis by name (n=69) only 29% received the diagnosis that theyhad searched.

Conclusion: The majority of patients used symptoms as the basis of their pre-ED presentation Internetsearch. When patients did search for specific diagnoses, only a minority searched for the diagnosisthey eventually received. [West J Emerg Med. 2017;18(5)928-936.]