Date of Degree


Document Type


Degree Name

Doctor of Business Administration (DBA)


Business Administration


Alberto Rubio


Alicia Rubio


Chris Nesser


Primary care-related emergency department use has become a focal point in the United States considering health reform and changes made to the delivery model and reimbursement mechanisms. Emergency departments serve as critical access points within the United States delivery system because important medical resources are made available for all members within the community. However, a gap in the literature exists due to a lack of consensus regarding factors that influence emergency department use for primary care-related health needs. The purpose of this study was to understand the relationship between demographic, social, economic, geographic, and need factors that influenced use of the emergency department for primary care-related health needs.

This study was modeled after the Andersen behavioral model of health care utilization, and it also utilized the New York University ED Algorithm to estimate the rate of visits that were primary care-related. This study employed a retrospective confirmatory research design using secondary administrative data obtained from the Kentucky State Emergency Department Database from January 1, 2008 to December 31, 2015 (N = 15,635,828).

All factors (insurance status, insurance type, income, area of residence, gender, race, and age) within the multi-factor logistic model were significant, except Race White, Missing insurance, and self-pay insurance.

The multi-factor model and ED Algorithm appear to have validity as an indicator of access problems to primary health care services. Findings from this study provide evidence that both community and individual level factors are influential in driving use of the emergency department for primary care-related health needs.