Association of office-based provider visits with emergency department utilization among publicly insured stroke survivors

Objective: To evaluate the association between visits to office-based providers and Emergency Department (ED) utilization among stroke survivors. Methods: We analyzed 12-years of data representing a weighted sample of 3,317,794 publicly insured US adults aged ≥18 years with stroke, using the Medical Expenditure Panel Survey Household Component (MEPS-HC), 2003–2014 dataset. We used a negative binomial regression model that accounts for dispersion to estimate the association between office-based and ED visits controlling for covariates. We used a multivariate logistic regression model to identify independent predictors of ED visits. Results: Annual mean (SD) ED visits and office based visits for publicly insured stroke survivors were 0.60 (1.10) and 12.2 (19.9) respectively. Each unit increase in office based visits was associated with a 1% increase in ED visit (p = 0.008). Being unmarried (adjusted OR = 1.26; 95% CI: 1.015–1.564) and having several comorbidities (adjusted OR = 1.93; 95% CI: 1.553–2.412) were associated with a higher likelihood of at least one ED visit. The odds for an ED visit for individuals aged 45–64, those aged 65 years and above, and those with a college or higher level of education were respectively 34% (OR = 0.66; 95% CI: 0.454–0.965), 52% (OR = 0.48; 95% CI: 0.330–0.701), and 36% (OR = 0.64; 95% CI: 0.497–0.834) lower than their counterparts. Conclusions: Contrary to our expectations, there was a direct relationship between ED visits and office base visits among U.S. stroke survivors. This finding may reflect the difficulties associated with managing stroke survivors with multiple co-morbidities or complex psycho-socio-economic issues.