To explore factors contributing to increased emergency department (ED) utilization, this retrospective chart review compared ED visits for a 2-week period in both 1992 and 2000 at a rural, tertiary medical center. Total ED visits increased 455 between the periods (% increase = 28.6%), whereas county population increased 18,253 (% increase = 16.1%) (P < 0.005). Average age increased from 35.2 +/- 23.8 years to 40.1 +/- 23.6 years (95% confidence interval, difference of means, 3.34 to 6.45). Patients over 80 years increased by 83%, whereas those over 90 years increased 138%. The admission rate, increased from 21.9% to 25.6% (P < 0.005). Patients with Medicare as primary insurance increased from 17.9% to 23.6% (P < 0.005). Increased age of the population, increased acuity as shown by 4 different measurements, and limited access to primary care physicians all contributed to increased ED demand in this study.
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