Non-traumatic dental visits to hospital-based emergency departments Rhode Island
AlSagob, Eman I.
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OBJECTIVES: (1) to investigate trends in non-traumatic dental visits (NTDV) to hospital-based emergency departments (ED) in Rhode Island (RI) and to compare them with those for other ambulatory sensitive care conditions (ACSC); (2) to examine the effect of expansion of Medicaid coverage on the rate NTDV to ED; (3) and to examine community-level factors associated with NTDVs. METHODS: Data for ED visits in 2005–2014 were obtained from RI hospital discharge data and annual population estimates from the U.S.Census Bureau, and were used to calculate annual visit rates. Medicaid enrollment report for the calendar years 2013 and 2014 were used to calculate monthly enrollment and an interrupted time series analysis was used to examine the effect of expansion of Medicaid coverage on visit rates. Zip code was used as a unit of analysis for community-level factor analysis, 2010 data. A negative binomial regression model with log link was performed. RESULTS: From January 2005 to December 2014, the annual average number of ED NTDV was 7440, accounting for 1.4–2.1% of all ED visits each year, there was a slight but not statistically significant decrease in the NTDV rate between 2005 and 2014. Visits for asthma also declined slightly, but the decrease was statistically significant. There were statistically significant increases in ED visit rates for diabetes and back pain. The NTDV rate increased by 34.8/100,000 enrollees per month immediately and significantly after expansion, amounting to more than 1000 additional ED visits. ED visits for asthma and back pain declined immediately after the expansion of coverage, but not significantly so. Community-level factors associated with NTDVs were higher level of poverty and communities with younger population (more individuals aged 20–34 years) which had significantly higher ED NTDV rates. CONCLUSION: RI NTDVs slightly declined, but still accounts for around 1.6% of ED visits. Medicaid expansion under the ACA, caused an immediate increase in NTDVs to ED, that might be attributed to the increased number of Medicaid enrollees, with no change in the workforce. Among community-level factors, high poverty level and high percent of young population had the highest impact on visit rates.