OBJECTIVES: Overcrowding in emergency departments (EDs) decreases the quality of care and increases hospital costs. Avoidable emergency department visits often indicate that the quality of primary care is subpar. This research aims to describe the characteristics and healthcare utilization of patients with avoidable emergency department (ED) visits and to explore the relationship between avoidable ED visits and the quality of primary care in Taiwan. A better understanding of this relationship could help inform strategies that seek to alleviate overcrowding in emergency departments.

METHODS: The 2010-2013 population-based National Health Insurance database which consists of one million enrollees in Taiwan is used in this study. Patients who had avoidable ED visit between 2010 and 2013 was selected as the case-group in this study and were matched to patients who had outpatient visits but without any avoidable ED visit in the same year. The continuity of care index (COCI) was used to measure the quality of primary care. Multivariate logistic regression analysis was applied to explore whether avoidable ED visits (ED visits for ambulatory care sensitive conditions) are associated with patients’ characteristics, the continuity of care, and the type of providers as their usual source of primary care.

RESULTS: The study found that patient who was male or with lower income class were associated with higher probability of having avoidable ED visits. The result of multivariate analysis further revealed that the odds of avoidable ED visits were higher for patients with lower continuity of care (OR = 1.924 to 3.22), and for whom received primary care from regional (medium) hospitals (OR = 3.543) and medical centers (OR = 2.916).

CONCLUSIONS: Higher continuity of care was found to significantly lower the risk of avoidable ED visits.