Emergency Department Utilization in Patients With Neurogenic Bladder: Contemporary Burden and National Trends in Prevalence, Inpatient Admission, and Associated Charges, 2006-2011.
Sood A, Phelps J, Palma-Zamora I, Jindal T, Abdollah F, Vuljaj A, Sammon JD, Trinh QD, Menon M, and Atiemo H. Emergency department utilization in patients with neurogenic bladder: Contemporary burden and national trends in prevalence, inpatient admission and associated charges 2006-2011. Urology 2017; 109:74-81.
OBJECTIVE: To quantify the national burden of neurogenic bladder disease, a chronic debilitating condition associated with frequent hospital visits, in the contemporary emergency care setting.
METHODS: Relying on the Nationwide Emergency Department Sample, 2006-2011, we abstracted patients presenting to the emergency department (ED) with neurogenic bladder utilizing International Classification of Diseases, Ninth Revision (ICD-9) codes. National trends in ED presentation, subsequent inpatient admission vs discharge, and associated charges were examined using the estimated annual percent change methodology.
RESULTS: Over the study period, a total of 875,066 patients with neurogenic bladder were seen in the ED, of which 538,532 (61.5%) were admitted. Total and median ED charges increased at an annual rate of 36.66% (P <.001) and 13.24% (P <.001), respectively, with total ED charges amounting to 87.48 million USD in the year 2011. Annual ED utilization also increased, although at a slower rate, 1.89% (P = .017). Inpatient admissions decreased at an annual rate of 3.67% (P <.001), whereas the use of long-term care facilities increased at 11.82% (P = .005).
CONCLUSION: Total ED charges are increasing at a dramatic rate, driven by the increasing utilization of the ED as an entry point to health care as well as the increasing per-visit charges. Encouragingly, the rates of inpatient admission are decreasing, likely secondary to improved triaging in the ED and increased utilization of long-term care facilities. It remains to be seen, however, whether the increased spending in the ED for better triaging and investment in long-term care facilities will translate into an overall economic benefit by reducing inpatient charges or not.
Medical Subject Headings
Adult; Aged; Cost of Illness; Emergency Service, Hospital; Female; Hospital Charges; Humans; Male; Middle Aged; Patient Admission; Prevalence; Time Factors; Urinary Bladder, Neurogenic