Mamou Fatema

The MSSS, described elsewhere (1), has been in use since 2003 and records Emergency Department (ED) chief complaint data along with the patient’s age, gender and zip code in real time. There were 85/139 hospital EDs enrolled in MSSS as of June 2012, capturing 77% of the annual hospital ED visits in Michigan. The MSSS is used routinely during the influenza season for situational awareness and is monitored throughout the year for aberrations that may indicate an outbreak, emerging disease or act of bioterrorism. The system has also been used to identify heat-related illnesses during periods of extreme heat. Very young children, the elderly, and people with mental illness and chronic diseases are at the highest risk of preventable heatrelated illnesses including sunburn, heat exhaustion, heat stroke and/or death (2). During a heat wave in the summer of 2012, data was reviewed on an ad hoc basis to monitor potential increases in heat-related ED visits.

Objective

The purpose of this work was to conduct an enhanced analysis of heat illness during a heat wave using Michigan’s Emergency Department Syndromic Surveillance System (MSSS) that could be provided to Public Health and Preparedness Stakeholders for situational awareness.

 

The MSSS, described elsewhere, has been in use since 2003 and records ED chief complaint data. As of September 2014, there were 88/136 hospital EDs enrolled in MSSS, capturing 83% of the annual hospital ED visits in Michigan.

On April 1, 2014 the Healthy Michigan Plan (HMP) was launched. HMP provides healthcare benefits to low-income adult residents who do not qualify for Medicaid or Medicare. The plan incorporates both federally and state mandated Essential Health Benefits, which includes emergency services.

As insurance coverage expands, more people will have the ability to utilize the services of primary care and other providers. In particular, this will affect previously uninsured, low-income populations who are disproportionately affected by chronic disease.

We question if access to these services will affect the utilization of emergency services as more people will have a medical home to manage and prevent diseases that may otherwise become an emergent issue. Furthermore, this increased access to health care services will expand care options for urgent but not emergent issues beyond EDs. Conversely, as more people acquire health care benefits the demand for primary care services may exceed the level of access to these services which may lead to an increase of ED utilization for primary care.

Objective

The purpose of this work is to use the Michigan Syndromic Surveillance System (MSSS) to assess emergency department (ED) utilization before and after the April 2014 implementation of the Healthy Michigan Plan, an expanded Medicaid program.