Lines, Lisa M.Rosen, Allison B.Ash, Arlene S.2022-08-232022-08-232017-11-012018-01-16<p>J Health Care Poor Underserved. 2017;28(4):1487-1508. doi: 10.1353/hpu.2017.0129. <a href="https://doi.org/10.1353/hpu.2017.0129">Link to article on publisher's site</a></p>1049-2089 (Linking)10.1353/hpu.2017.012929176110https://hdl.handle.net/20.500.14038/29217Much of emergency department use is avoidable, and high-quality primary care can reduce it, but performance measures related to ED use may be inadequately risk-adjusted. To explore associations between emergency department (ED) use and neighborhood poverty, we conducted a secondary analysis of Massachusetts managed care network data, 2009-2011. For enrollees with commercial insurance (n = 64,623), we predicted any, total, and total primary-care-sensitive (PCS) ED visits using claims/enrollment (age, sex, race, morbidity, prior ED use), network (payor, primary care provider [PCP] type and quality), and census-tract-level characteristics. Overall, 14.6% had any visit; mean visits per 100 persons were 18.8 (+/-0.2) total and 7.6 (+/-0.1) PCS. Neighborhood poverty predicted all three outcomes (all P < .001). Holding providers accountable for their patients' ED use should avoid penalizing PCPs who care for poor and otherwise vulnerable populations. Expected use targets should account for neighborhood-level variables such as income, as well as other risk factors.en-USEmergency ServiceHospitalutilizationclaims analysiselectronic health recordssmall-area analysisrisk assessmentpovertyEmergency MedicineHealth EconomicsHealth Services AdministrationHealth Services ResearchJournal Articlehttps://escholarship.umassmed.edu/faculty_pubs/144911368909faculty_pubs/1449