Eyeworld

EW NEWS & OPINION 18 May 2017 Research highlight by Vanessa Caceres EyeWorld Contributing Writer conditions deemed not urgent by the attending physician or non-ur- gent based on the investigators' own classification. The multiple ED visits that sometimes occurred leads to numbers that add up to more than 100%. Some common diagnoses not classified as urgent or non-urgent were "other specified visual dis- turbance" and "pain in or around the eye," based on International Classification of Diseases (ICD-9-M) classifications. The total number of people who visited the ED for ocular conditions grew 30% over the study period, with more visits occurring in 2014 compared with 2001. However, the number of visits classified as urgent or non-urgent remained stable, they reported. The mean age of all enrollees was 47.4 years old, and 56.6% were women. Those who sought care for a non-urgent condition were slightly younger and more likely to be black or Latino. The most common non-urgent diagnosis was conjunctivitis, and the three most common urgent diag- noses were orbital cellulitis, corneal ulcer, and giant cell arteritis. As annual income increased, seeking treatment at the ED for any ocular condition lowered. Those who sought care in the ED for any health problem also were more likely to seek care there for ocular problems, the investigators found. Having an eyecare provider increased the chance of ED visits for urgent problems—there was a 14% increased hazard relative to enroll- ees who did not have an eyecare provider. Analysis The overall increase in ED visits for ocular conditions is consistent with an overall increase in all ED visits since enactment of the Patient Pro- tection and Affordable Care Act, the investigators noted. "As such, many insurance plans had an influx of young adults as well as racial minorities and less affluent persons who previously did have health insurance," they wrote. Younger patients may have been more likely to seek eyecare at the ED because they are less likely to have visual acuity or rarely need care in an ED setting. Examples of urgent conditions included retinal detachment, cor- neoscleral laceration, and temporal arteritis. If patients had multiple diagnoses and at least one was urgent, then the visit was classified as urgent. There were also some visits as "other" because it was not easy to determine if the situation was urgent or non-urgent. Take, for in- stance, corneal abrasions. "Although most corneal abrasions heal quick- ly and without sequelae and thus could be viewed as non-urgent, from the patient's perspective, the intense pain and occasional blurred vision caused by corneal abrasions could reasonably justify a visit to an ED for evaluation and management," they wrote. Results Of 11.1 million eligible enrollees in the managed care network, 376,680 (3.4%) had at least one ED visit for an ocular condition. Of those, 23% were seen for a non-urgent condi- tion, 6.7% were seen for an urgent condition at least once, and 72.5% had one visit or more for ocular "First, many of these patients can be managed safely and effective- ly in an outpatient clinical setting instead. Second, ED visits cost, on average, four times more than visits to an office setting for compara- ble medical problems, resulting in $580 in higher costs per visit. Third, non-urgent medical conditions may contribute to ED overcrowding, which can lead to delay in the care of other patients with more urgent medical problems." Investigators wanted their research to identify the problems and patient characteristics most often associated with non-urgent ocular conditions to help search for alternative ways to manage these conditions. Study methods Claims information with an eye-re- lated diagnosis from a managed care network between Jan. 1, 2001, and Dec. 31, 2014, were included. The investigators identified claims that were classified as ED visits. They also categorized claims as urgent or non-urgent. The non-urgent condi- tions were blepharitis, conjunctivi- tis, or chalazion and were identified as such because they rarely affect What makes some patients more likely to visit the emergency department for urgent or non-urgent conditions? I t's after-hours, and someone experiences eye pain. The per- son suspects it's an emergency but isn't sure. This person does not see an eye doctor regularly and will likely go to the emergency room—but is that the right choice? A new study found that 23% of those who visited the emergen- cy department (ED) for an ocular problem actually had a non-urgent condition. 1 They study, published online in Ophthalmology, is led by Brian C. Stagg, MD, Department of Ophthalmology and Visual Scienc- es, University of Michigan Medical School, Ann Arbor. The study was conducted in the context of a major increase in ED visits, from 108 million in 2000 to 130 million in 2010, the investiga- tors wrote. They added that previous research has found that around 40% of all visits to the ED are for non-ur- gent conditions. 2 Analyzing ocular emergency department visits

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