Cutler Institute for Health and Social Policy

Population Health and Health Policy

Analysis of 2006 Maine Emergency Department Use


This study, conducted on behalf of the Emergency Department Use Work Group of the Maine Advisory Council on Health System Development provides an analysis of visits to hospital emergency departments in Maine that took place in 2006. The study relied on two sources of data: a comprehensive file of hospital discharge records provided by the Maine Health Data Organization; and comprehensive claims records for most privately insured residents in Maine and most MaineCare members. The 2006 data used for this analysis pre-dated some of the initiatives undertaken by the Department of Human Services to improve access to primary care and reduce emergency department use among MaineCare members.<p></p>
Key findings with regard to emergency department (ED) use:<li>
Maine's emergency department use in 2006 was, in aggregate, about 30% higher than the national average.
<li>Maine's rate of use in every age cohort was higher than the national average for the same age cohort.
<li>The highest prevalence of frequent ED users (4 or more visits in a year) is found among infants, and 19 to 24 year olds.
<li>Use of emergency department care for outpatient care by MaineCare members is more than three times as high (918 outpatient visits per 1000) as rates of use by privately insured residents (284 per 1000).
<li>The uninsured are responsible for 9 percent of emergency department visits. ED visits by uninsured patients are concentrated among young adults. Between the ages of 15 and 44, 15 percent of emergency department visits are generated by the uninsured.
<li>Rate of emergency department use varies substantially by health service area; Geographic variation in emergency department use rates is seen among both privately insured and MaineCare members with substantial overlap of high and low use areas for these two populations, suggesting that use rates are affected by area-specific health system factors that affect the total population.
<li>A review of diagnoses frequently seen in emergency departments in Maine suggests that a substantial number of visits are made for conditions that could be appropriately treated in office or clinic settings.</li>

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Publish Date: 
February 1, 2009

Cutler Institute awarded $600,000 to help youth raised in foster system

Marty Zanghi

USM's Cutler Institute for Health and Social Policy has been awarded a $600,000 grant to help young people raised in Maine's foster system to prepare for college and the workforce.

The money comes from the Annie E. Casey Foundation as part of a $5.4 million national effort aimed at youth who are homeless or in either the foster care or juvenile justice systems.

"Many of these young people have suffered abuse or trauma and were raised in poverty and neglect," said Marty Zanghi, the Cutler Center's youth development director.

The money -- including an expected $400,000 more in matching funds -- will pay for contracted work with agencies in the target areas, starting with the greater Portland area and Penobscot, Kennebec and Somerset counties.

Nationally and in Maine, only about 3 percent of people who grow up in the foster care system achieve a college degree, he said.

"It's dramatically lower than the rate for the general population," Zanghi said. "It's a horrible outcome."

It doesn't have to be that way, though.

"There are young people that overcome these circumstances," he said. "I know people who have master's degrees and Ph.Ds."

The Casey Foundation's national effort is being called the "Learn and Earn to Achieve Potential" (LEAP) initiative.

The initiative is working on partnerships in Maine and nine other areas: Alaska, Arizona, California, Massachusetts, Michigan, Minnesota, Nebraska and New York. In each case, people will adapt two evidence-based models to meet the needs of these youth, including support to address the trauma they may have experienced in their lives.

In Maine, the work will include a pair of successful programs, Jobs for Maine Graduates (JMG) and Jobs for the Future. Results will be carefully tracked, Zanghi said.

After the first year, the program is expected to grow.

"Eventually, the additional help will be available to all children, 14 and over, in the foster care system in the state of Maine," Zanghi said.

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