Emergency department usage patterns among residents of Hardin, Jefferson, and Orange Counties in southeast Texas

Emergency departments (EDs) have been called the net below the safety net due to their long history of providing care to the uninsured and others lacking access to the healthcare system. In past years, those with Medicaid and, more recently, those with Medicare, are also utilizing the ED as a medical home for routine primary care. There are many reasons for this but the costs to the community have become increasingly burdensome. ^ To evaluate how often the ED is being utilized for primary care, we applied a standardized tool, the New York University Algorithm, to over 43,000 ED visits when no hospitalization was required made by Hardin, Jefferson, and Orange County residents over a 12 month period. We compared our results to Harris County, where studies using the same framework have been performed, and found that sizeable segments of the population in both areas are utilizing the ED for non-emergent primary care that could be treated in a more cost-effective community setting. ^ We also analyzed our dataset for visit-specific characteristics. We found evidence of two possible health care disparities: (1) Blacks had a higher rate of primary care-related ED visits in relation to their percentage of the population when compared to other racial/ethnic groups; and (2) when form of payment is considered, the uninsured were more likely to have a primary care-related ED visit than any other group. These findings suggest a lack of community-based primary care services for the medically needy in Southeast Texas. ^ We believe that studies such as this are warranted elsewhere in Texas as well. We plan to present our findings to local policy makers, who should find this information helpful in identifying gaps in the safety net and assist them in better allocating scarce community resources. ^

Early days and Indian ways; the journal of Madge Hardin Walters.

Mode of access: Internet.

Rutherford Mound, Hardin County, Illinois.

Bibliography: p. 43-44.

Speech of the Hon. Ben Hardin, on the subject of the removal of the deposites. Delivered in the House of Representatives, April 1 and 3, 1834.

Mode of access: Internet.

Speech of Mr. Hardin of Kentucky, on Mr. Adam's resolutions concerning the loss of the fortification bill of the last session : delivered in the House of Representatives, January 28, 1836.

Cf. Congressional Globe, Jan. 22, 1836 for resolutions of John Quincy Adams.

Speech of Mr. J.J. Hardin, of Illinois : reviewing the principles of James K. Polk & the leaders of modern democracy, delivered in the House of Representatives of the United States, June 3, 1844.

Mode of access: Internet.

Guide leaflet, geological science field trip, Rosiclare area : Hardin County, Golconda, Cave in Rock, Shawneetown, and Equality Quadrangles /

April 12, 1958.

Plan of facine work for bluff. Grounds of Mr. John H. Hardin. Hubbard Woods, Illinois.

Ink on linen. Signed. 106 cm. x 64 cm. Scale: 1"=10' [from photographic copy by Lance Burgharrdt]

Revised planting plan for grounds of Mr. J. H. Hardin. Hubbard Woods, Illinois.

Ink on linen; location, type, amount of plantings. Signed. 108 cm. x 55 cm. Scale: 1"=20' [from photographic copy by Lance Burgharrdt]

Plan for water and drain pipes of pool. Garden of J. H. Hardin, esq. Hubbard Woods [Illinois]

Red, black ink on tracing paper. Signed. 48 cm. x 28 cm. Scale: 1"=20' [from photographic copy by Lance Burgharrdt]