Skip to main content
SpringerLink
Log in

Where health and welfare meet: Social deprivation among patients in the emergency department

  • Original Articles
  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

Context

As a safety net provider for many disadvantaged Americans, the emergency department (ED) may be an efficient site not only for providing acute medical care, but also for addressing serious social needs.

Objective

To characterize the social needs of ED patients, and to evaluate whether the most disadvantaged patients have connections with the health and welfare system outside the ED.

Design

Cross-sectional survey conducted over 24 hours in the fall of 1997.

Setting

Three EDs: an urban public teaching hospital, a suburban university hospital, and a semirural community hospital.

Participants

Consecutive patients presenting for care, including those transported by ambulance. The survey response rate was 91% (N=300; urban=115, suburban=102, rural=83).

Main Outcome Measure

Index of socioeconomic deprivation described by the US Census Bureau (based on food, housing, and utilities).

Results

Of all ED patients, 31% reported one or more serious social deprivations. For example, 13% of urban patients reported not having enough food to eat, and 9% of rural patients reported disconnection of their gas or electricity (US population averages both less than 3%). While 40% of all patients had no consistent health care outside the ED (≤1 visit/year), those with higher levels of social deprivation had the least contact with the health care system outside the ED (P<.01). Although those with higher levels of deprivation were more likely to receive public assistance, still almost one-quarter of patients with high-level social deprivation were not receiving public aid.

Conclusion

Many ED patients suffer from fundamental social deprivations that threaten basic health. The most disadvantaged of these patients frequently lack contact with other medical care sites or public assistance networks. Community efforts to address serious social deprivation should include partnerships with the local ED.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986, PL 99-272, 42 USC, 1395dd, 1985.

  2. American Public Welfare Association, the National Governors’ Association, and the National Conference of State Legislators. An Analysis of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Washington, DC: American Public Human Services Association; August 22, 1996:12.

    Google Scholar 

  3. US General Accounting Office. Emergency Departments: Unevenly Affected by Growth and Change in Patient Use. Report to the Chairman, Subcommittee on Health for Families and the Uninsured, Committee on Finance, US Senate. Washington, DC: US General Accounting Office; January 1993. Publication GAO/HRD-93-4.

    Google Scholar 

  4. McCaig LF. National Hospital Ambulatory Medical Care Survey: 1998 Emergency Department Summary. Advance Data: Vital and Health Statistics of the CDC, No. 313. Hyattsville, MD: National Center for Health Statistics; May 10, 2000.

    Google Scholar 

  5. Bunker JP, Gomby DS, Kehrer BH, eds. Pathways to Health: the Role of Social Factors. Menlo Park, CA: The Henry J. Kaiser Family Foundation; 1989.

    Google Scholar 

  6. Federman M, Garner T, Short K, et al. What does it mean to be poor in America? Monthly Labor Rev. May 1996:3–17.

  7. Short K, Shea M. Beyond poverty, extended measures of well being: 1992. Current Population Reports: Household Economic Studies. US Census Bureau P70-50RV. Washington, DC: Government Printing Office; November 1995.

    Google Scholar 

  8. US Census Bureau. Survey of Income and Program Participation: Extended Well-Being Topical Module (Wave 3), 1992. Washington, DC: US Department of Commerce, 1992.

    Google Scholar 

  9. US Department of Health and Human Services. National Health Interview Survey, 1994. Hyattsville, MD: National Center for Health Statistics; 1994.

    Google Scholar 

  10. Freeman HE. National Survey of Access to Health Care, 1986. Princeton, NJ: The Robert Wood Johnson Foundation, 1989.

    Google Scholar 

  11. Young GP, Wagner MB, Kellermann AL, Ellis J, Bouley D. Ambulatory visits to hospital emergency departments: patterns and reasons for use. JAMA. 1996;276:460–465.

    Article  CAS  PubMed  Google Scholar 

  12. Newacheck P. Poverty and childhood chronic illness. Arch Pediatr Adolesc Med. 1994; 148:1143–1149.

    CAS  PubMed  Google Scholar 

  13. Gordon JA. Emergencycare as a safetynet [letter]. Health Aff. March–April 2000; 19(2):277.

    Article  CAS  Google Scholar 

  14. Hart RG, Ghidorzi AJ, Van Rooyen MJ, Moran TJ. Discharge information for emergency department patients [letter to the editor]. Ann Emerg Med. 1996;27(3):392.

    Article  CAS  PubMed  Google Scholar 

  15. Jerome GV, Hedges JR, Mann NC. A structured approach to developing a community organization database [letter to the editor]. Acad Emerg Med. 1996;3(10):984–987.

    Article  CAS  PubMed  Google Scholar 

  16. Goldberg RM, Bernstein E, Anglin D, Cotler M, Hayne R, Travnitz R. Health promotion and disease prevention in the emergency department. In: Bernstein E, Bernstein J, eds. Case Studies in Emergency Medicine and the Health of the Public. Sudbury, MA: Jones and Bartlet Publishers; 1996:316–328.

    Google Scholar 

  17. Gordon JA. The hospital emergency department as a social welfare institution. Ann Emerg Med. 1999;33(3):321–325.

    Article  CAS  PubMed  Google Scholar 

  18. Ling LJ, Cooke JS, Kornfeld E. New models for emergency and ambulatory care at academic health centers—Part 1: New York City. Acad Emerg Med. September 1995; 2(9):836–843.

    Article  CAS  PubMed  Google Scholar 

  19. Gerson LW, Rousseau EW, Hogan TM, Bernstein E, Kalbfleisch N. Multicenter study of case finding in elderly emergency department patients. Acad Emerg Med. 1995;2: 729–734.

    Article  CAS  PubMed  Google Scholar 

  20. Bernstein E, Bernstein J, Levenson S. Project ASSERT: an ED based intervention to increase access to primary care, preventative services, and the substance abuse treatment system. Ann Emerg Med. 1997;30(2):181–189.

    Article  CAS  PubMed  Google Scholar 

  21. Birnbaum A, Calderon Y, Gennis P, Rama R, Gallagher EJ. Domestic violence: diurnal mismatch between need and availability of services. Acad Emerg Med. 1996;3(3):246–251.

    Article  CAS  PubMed  Google Scholar 

  22. Wrenn K, Rice N. Social-work services in an emergency department: an integral part of the health care safety net [includes “Further thoughts from the reviewers”]. Acad Emerg Med. 1994;1:247–253.

    Article  CAS  PubMed  Google Scholar 

  23. Keehn DS, Roglitz C, Bowden ML. Impact of social work on recidivism and non-medical complaints in the emergency department. Soc Work Health Care. 1994;20(1):65–75.

    Article  CAS  PubMed  Google Scholar 

  24. Boyack V, Bucknum AE. The quick response team: a pilot project. Soc Work Health Care. 1991;16(2):55–68.

    Article  CAS  PubMed  Google Scholar 

  25. Gordon JA. Cost-benefit analysis of social work services in the emergency department: a conceptual model. Acad Emerg Med. January 2001;8:54–60.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Emergency Medicine, Harvard Medical School, Boston, Massachusetts

    James A. Gordon MD, MPA

  2. Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts

    James A. Gordon MD, MPA

  3. Institute for Health Policy Massachusetts General Hospital/Partners Health Care System, Boston, Massachusetts

    James A. Gordon MD, MPA

  4. Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, Pennsyvania

    Carl R. Chudnofsky

  5. Robert Wood Johnson Clinical Scholars Program and Department of Internal Medicine, University of Michigan Health System, Department of Veterans Affairs, VA Medical Center, Ann Arbor, Michigan

    Rodney A. Hayward

Authors
  1. James A. Gordon MD, MPA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carl R. Chudnofsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rodney A. Hayward
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James A. Gordon MD, MPA.

Additional information

At the time of this work, Dr. Gordon was supported at the University of Michigan by the Robert Wood Johnson Clinical Scholars Program and the Department of Veterans Affairs. Both Dr. Gordon and Dr. Chudnofsky were in the Department of Emergency Medicine at the University of Michigan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gordon, J.A., Chudnofsky, C.R. & Hayward, R.A. Where health and welfare meet: Social deprivation among patients in the emergency department. J Urban Health 78, 104–111 (2001). https://doi.org/10.1093/jurban/78.1.104

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1093/jurban/78.1.104

Keywords

Search

Navigation