Estimating resource utilization for emergency department visits by patients' HIV seropositivity in the United States, 2009 to 2018

Khairul A Siddiqi; Yiyang Liu; Delaney D Ding; Bankole A Olatosi

doi:10.1016/j.ajem.2021.12.025

Estimating resource utilization for emergency department visits by patients' HIV seropositivity in the United States, 2009 to 2018

Am J Emerg Med. 2022 Mar:53:73-79. doi: 10.1016/j.ajem.2021.12.025. Epub 2021 Dec 18.

Authors

Khairul A Siddiqi¹, Yiyang Liu², Delaney D Ding³, Bankole A Olatosi⁴

Affiliations

¹ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States. Electronic address: ksiddiqi@ufl.edu.
² Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.
³ Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
⁴ Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, United States.

PMID: 34995859
DOI: 10.1016/j.ajem.2021.12.025

Abstract

Introduction: The Emergency Department (ED) plays a key role in linkage to and engagement in care for people with HIV (PWH) in the United States, particularly for individuals without a routine source or schedule for care. Assessing patterns of ED resource utilization by PWH can help elucidate the role of EDs across the HIV care continuum. The aim of this study was to use visit-level data to characterize resource utilization patterns for HIV-related ED visit diagnoses compared to those of other ED visit types.

Methods: HIV-related ED visits were identified as either having answered 'have HIV' in a survey question, been diagnosed with HIV, or had HIV noted as a reason for a visit. Weighted, pooled cross-sectional analyses were performed using the National Hospital Ambulatory Medical Care Survey (NHAMCS) for 2009-2018. ED visits were restricted to those aged 13 years and older. Both descriptive and multivariable regression analyses were performed using Stata 15.1 to measure differences in ED resource utilization.

Results: A weighted total of 6.10 million ED visits occurred among PWH, representing 5.5 visits per 1000 ED visits. The rates of HIV-related ED visits (per 1000 ED visits) were higher among patients aged 50-64 years (9.1), males (7.9), African Americans (11.1), Medicaid recipients (7.8), patients in the Northeast (6.8), and patients in metropolitan areas (MSA) (6.1). HIV-related ED visits reflected higher resource utilization: including higher utilization of the ambulance, diagnostic tests, blood tests, urinalysis, HIV tests, intravenous fluids, medications, consultants, critical care units, longer visits, and hospital admissions. Multivariable regression models revealed higher ED resource utilization and showed that patients making HIV-related visits were 57% more likely to result in hospital admission, spending 17% more time compared to patients making non-HIV-related visits.

Conclusion: Hospitals should be prepared to meet the unique needs of PWH presenting for ED services. Continued surveillance of resource utilization patterns among PWH in EDs is important to plan successful HIV care engagement interventions in these settings.

Keywords: Emergency department; HIV; National estimates; Resource utilization; United States.

MeSH terms

Adolescent
Cross-Sectional Studies
Emergency Service, Hospital
HIV Seropositivity*
Health Care Surveys
Humans
Male
Medicaid
Middle Aged
United States / epidemiology