Regular Source of Ambulatory Care and Medical Care Utilization by Patients Presenting to a Public Hospital Emergency Department

Published In: JAMA, The Journal of the American Medical Association, v. 271, no. 24, June 22-24, 1994, p. 1909-1912

Posted on RAND.org on December 31, 1993

by David P. Baker, Carl Stevens, Robert H. Brook

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Using emergency departments as regular sources of care has been considered to be a marker of poor quality because it is difficult to provide continuity of care in that setting. This study examined the relationship between a regular source of ambulatory care and the use of a public hospital emergency department. The study was based on more than 1,000 ambulatory adults presenting to the emergency department of a Los Angeles County public hospital during a two-week period. Twenty-nine percent identified no regular source of care, 16 percent identified the emergency department as their regular source of care, and 56 percent identified a regular source of care other than the emergency department. Of those who identified a source of care other than the emergency room, 24-36 percent of their recent physician visits still occurred in an emergency department. Patients who identified an emergency department as their regular provider had 25 percent fewer physicians visits than did those with another regular source of care. The study concluded that emergency department patients rely heavily on the emergency department for ambulatory physician visits, regardless of their reported regular source of care, and patients who identify an emergency department as their regular source of care use physician services less frequently than those with access to providers in other settings. These issues and their effect on quality require further evaluation with population-based surveys.

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