Improving Emergency Department Utilization Rates and Quality of Health Among Uninsured Hispanics

Solutions are needed to address the overutilization of emergency departments (EDs) for ongoing and non-emergency conditions among uninsured Hispanic patients. The purpose of this review was to synthesize available evidence related to hospital utilization rates for non-emergency conditions and quality of health and to provide strategies for leaders to reduce ED utilization rates for uninsured Hispanics. An integrative review was conducted of existing literature published between 2020 and 2024. Thematic analysis identified four significant themes: (a) insurance coverage, (b) high-risk uninsured patients, (c) ED, and (d) healthcare payment models. The 12 subthemes identified were (a) non-expansion Medicaid states, (b) delay in healthcare services, (c) financial barriers, (d) chronic conditions, (e) medication costs and adherence, (f) Emergency Medical Treatment and Labor Act, (g) frequent and treat-and-release visits, (h) healthcare costs, (i) primary care services and accessibility, (j) healthcare quality, (k) fee-for-service model, and (l) valuebased reimbursement strategies. The Donabedian SPO model supports healthcare administrators and community leaders in implementing strategies to improve ED utilization rates. These strategies include insurance expansion, funding for unexpected healthcare emergencies, collaborative work with community-based healthcare providers, transition to outpatient and primary care services, value-based care, and post discharge programs. Such strategies can permit EDs to provide coordinated medical care to highrisk uninsured Hispanic patients, allowing for positive social change through a reduction in ED utilization rates for non- emergency medical conditions and enhancement in patients’ quality of health.