Date of Award
Doctor of Philosophy (PhD)
Alison M. Buttenheim
Problem statement: Non-urgent emergency department (ED) utilization leads to greater risk of ED overcrowding and potentially negative outcomes for patients. Increased understanding of why some patients continue to use EDs for non-urgent care despite the increasing availability of lower cost alternatives such as urgent care clinics (UCC) is needed. The aim of this three-article dissertation was to: 1) assess current literature on non-urgent care utilization across different healthcare service settings, 2) examine the impact of opening a same brand UCC on non-urgent ED utilization for the treatment of uncomplicated urinary tract infections (UTI) among those who live closest to the recently opened UCC, and 3) assess differences in predisposing, enabling, illness, and cognitive bias levels among young adult women who seek uncomplicated UTI treatment at EDs compared to those who attend UCCs.
Procedure and Methods: A systematic literature review was conducted on non-urgent ED patient comparisons across multiple healthcare service settings. The impact of opening a same brand UCC on ED utilization for uncomplicated UTIs was assessed with a retrospective cohort study. Lastly, a quantitative cross-sectional online survey administered through Turk Prime was conducted to assess differences among young adult women who sought uncomplicated UTI treatment at EDs versus UCCs.
Results: There remains a continued need for literature comparing non-urgent patients across multiple service settings. The opening of a same branded UCC had little impact on non-urgent ED utilization for the treatment of uncomplicated UTIs for patients living in four zip codes nearest to the UCC and belonging to a single large healthcare system. Given an uncomplicated UTI ED visit, a person was significantly more likely to have had abdominal pain (Exposure odds (Exposure odds (EO)) 3.13 (95% CI 1.51-6.75)) and more risk averse (EO 5.53 (95% CI 1.75-18.91)) compared to those who sought treatment at an UCC in an online survey sample.
Conclusions: Using a single diagnosis of uncomplicated UTIs as well as cognitive bias measures was useful in identifying novel insights into non-urgent ED utilization. Cognitive biases and symptom/diagnosis specifics variables should continue to be studied in comparisons of non-urgent patients across different healthcare settings.
Brown, Jason R., "Examining The Choice To Seek Non-Urgent Urinary Tract Infection Treatment At Emergency Departments" (2019). Publicly Accessible Penn Dissertations. 3554.