Impact of Proximity and Accessibility of Urgent Care Centers on Emergency Department Utilization for Non-emergent Visits

Introduction Social determinants of health, including transportation, impact access to healthcare and health outcomes. Urgent Cares (UCs) play an important role in caring for minor injuries and ailments but are asymmetrically distributed and often located in or near more affluent communities. Accessibility of UCs by public and private transit varies widely. While UCs can address acute healthcare needs that do not require emergent treatment, location and transit times may influence their utility. This study aims to characterize the relationship between transit times to different healthcare facilities and ED utilization for non-emergent visits. Methods Publicly available ED utilization data was obtained for Milwaukee County from 2019-2020. ED visits by ZIP code were categorized as either emergent or non-emergent as defined by the validated New York University - Emergency Department Visit Algorithm (NYU-EDA) classification system. A Google Maps application programming interface was used to compute the public and private transit times between the population center of each census tract and its nearest UC and ED. Associations between transit times and the percent of non-emergent ED utilization were measured. Results Median transit times were shorter to EDs than UCs across the county. Decreased transit times to EDs were associated with increased ED utilization for non-emergent complaints across both private and public transportation methods (p=0.23 and p=0.02, respectively). Increased transit time to UCs was associated with increased ED utilization for non-emergent complaints across private and public transportation (p=0.07 and p=0.34). Conclusions Decreased transit times to EDs and increased transit times to UCs are associated with increased ED utilization for non-emergent complaints. This suggests accessibility and geographic proximity may play a role in patient choices regarding where to seek care and carries public health and healthcare policy implications.