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Medical Group Practice Characteristics Influencing Inappropriate Emergency Department and Avoidable Hospitalization Rates

Kralewski, John PhD, MHA; Dowd, Bryan PhD, MS; Knutson, Dave MA; Savage, Megan BS; Tong, Junliang MS

Journal of Ambulatory Care Management: October/December 2013 - Volume 36 - Issue 4 - p 286–291
doi: 10.1097/JAC.0b013e3182a33287
Original Articles

The inappropriate use of emergency departments (EDs) and ambulatory care sensitive hospital admission rates by patients attributed to a national sample of 212 medical group practices is documented, and the characteristics of practices that influence these rates are identified. Hospital-owned practices have higher nonemergent and emergent primary care treatable ED rates and higher ambulatory care sensitive hospitalization rates. Practices with electronic health records have lower inappropriate ED rates but those in rural areas have significantly higher rates. Practices with lower operating costs have higher inappropriate ED and ambulatory care sensitive rates, raising questions about the costs of preventing these incidents at the medical group practice level.

Division of Health Policy & Management, University of Minnesota, Minneapolis, Minnesota (Drs Kralewski and Dowd and Mr Knutson); and Medica Research Institute, Minnetonka, Minnesota (Dr Kralewski, Ms Savage, and Mr Tong).

Correspondence: John Kralewski, PhD, MHA, Medica Research Institute, 301 Carlson Parkway, Minnetonka, MN 55305 (

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins