Research Forum Abstracts

claims data and government records has been shown to be a valid way to evaluatehealth care utilization of at risk populations and could be used to describe health careutilization of child abuse victims, substance abuse patients, etc.

Figure 1. Date of healthcare visit compared to date of victimization

Healthy Neighborhoods and the

195 EMF Emergency Department: IsNeighborhood Healthy FoodAvailability Associated WithEmergency Department Presentationsfor Diet-Related Illness?

Westgard B, Dahl E/HealthPartners, Regions Hospital, Minneapolis-Saint Paul, MN

Study Objectives: Diet and nutrition have long been acknowledged as importantcontributors to the health and illness of individuals. More recent analysis of the socialdeterminants of health have suggested that neighborhoods with poor healthy foodavailability poor access may be to poorer nutrition, a higher prevalence of hunger, andparadoxically a higher prevalence of obesity and other illnesses. Aggregate survey data aswell as qualitative interviews and focus groups conducted by St. Paul/Ramsey CountyPublic Health suggest that areas of low healthy food availability exist in St. Paul and arefelt by community members to contribute to poor health and diet-related illness (DRI).Our research uses geographic information systems (GIS) and spatial analysis to examineassociations between neighborhood healthy food availability and emergencydepartment (ED) presentations for DRI.

Methods: Using public health department information and the NutritionalEnvironment Measures Survey in Stores (NEMS-S), we conducted a field-survey ofhealthy food availability in all retail food outlets located within the city limits ofSt. Paul, Minnesota. We then used a previously validated algorithm and GIS toaggregate that data into a Healthy Food Availability Index (HFAI) score for each USCensus block group in St. Paul. Using aggregate community ED-usage data from theMinnesota Department of Health and ED-presentation data from Regions Hospital,we were then able to map the incidence of ED-use-adjusted DRI presentations byblock group. We defined ED-presentations for DRI as those with ICD-9 diagnosescodes for diabetes, hypertension, malnutrition and/or dehydration. We then performedcluster analysis using the Local Moran’s I as well as more thorough modeling ofrelative-risk through Poisson regression, while adjusting for multiple census-derivedcovariates as well as spatial autocorrelation between block groups.

Results: Though preliminary, our spatial cluster analysis using GIS demonstratesan overlap between those areas with low HFAI scores and those areas with higherincidence of ED presentation for DRI. It remains to be seen to what degree this isborne out by our spatial statistical analysis.

Conclusions: ED presentations provide a proverbial canary in the coal mine fordeveloping community health concerns, reflecting not only their prevalence but alsotheir severity, as well as the absence of local factors to support wellness. GIS analysisprovides one means of linking ED presentations and concerns with the health ofneighborhoods. Establishing and understanding the link between healthy foodavailability and DRI may help explain certain neighborhood health disparities. Similar

Volume 62, no. 4s : October 2013

analyses may allow us to address disparities by providing focused health resources in theED and developing collaborative health care and community responses to improve thehealth of our neighborhoods.

Increasing Prevalence of Adult-Onset Diabetes Mellitus

196 in Patients Seeking Care in the Emergency DepartmentSterling SA, Cox RD/University of Mississippi Medical Center, Jackson, MS

Background: Diabetesmellitus (DM) is one of themajor health problems in theworldtoday. Estimatedmedical costs formedical care of thosewithDMare $116 billion per year.

Study Objective: The objective of this study was to examine the longitudinaltrends in DM in emergency department (ED) patients and evaluate the factors thatimpacted those trends.

Methods: The presence of DM, height and weight were entered prospectively inED patients between 2006 and 2011. Body Mass Index (BMI) was calculated as weightin kilograms/height in meters squared. The setting was a university-based teachinghospital located in the Southern United States with an average yearly volume of 57,000to 70,000 over the six-year study. The study population included all patients greaterthan 16 years of age who presented to the ED in which height, weight, and history ofDM were documented. The racial makeup of the patient population was 72.5%African American, 26.7% Caucasian and 0.8% other. Data were analyzed in one-yearblocks then examined for trends using linear regression analysis. The data were alsoexamined by obesity class - normal (BMI 20-24.9 kg/m2), overweight (BMI 25-29.9kg/m2), obese (BMI 30-39.9 kg/m2), and extreme obesity (BMI >40 kg/m2).

Results: There was a strong positive trend showing increasing prevalence of adult-onset diabetes mellitus (AODM) over the study period. The percentage of AODM for allpatient visits increased progressively from 10.7% to 16.1% (r2 0.97). The percentage ofpatients with AODM increased from 8.4% to 12.5% (r2 0.95). No changes in thepercentage of juvenile-onset DMwere seen over the study period. Progressive increases inyearly AODM prevalence were observed for all BMI classes. The rate of change in theincrease of DM was directly related to the degree of obesity. For the extreme obesitycategory, the percentage of patients with DM increased 1.4% per year (r2 0.94), obesity1.0% per year (r2 0.90), overweight 0.7% per year (r2 0.88) and normal weight 0.5% peryear (r2 0.92). The absolute change in the percentage ofDM in those with extreme obesityranged from 18.4% to 24.9%. The patient age increased slightly for all obesity groups,accounting for 0.2-0.4% per year increase in the prevalence of DM in the population.

Conclusions: National and state data on the prevalence of DM are currently basedon telephone interviews, a national survey or ED discharge diagnoses. This studyfocused on patients seeking care in the ED for any reason. These data show not only asteady increase in ED visits by patients with DM, but also a steady increase in theprevalence of patients with DM. Analyses thus far indicate that these increases areinfluenced by the obesity level of the patient and by patient age. Since this study wasperformed in one of the states with the highest obesity rate in the country, these resultsmay not be applicable to EDs in other areas.

Quality Improvement in Physician Disclosure and

197 Linkage to Care of Those Newly Diagnosed With HIV inan Urban Level I Trauma Center Emergency DepartmentPerforming Universal Screening

Scribner JT/John Peter Smith Health Network, Fort Worth, TX

Study Objectives: In spite of improvements in treatment, HIV/AIDS remains oneof the leading causes of death and disability in the United States. In the year prior todiagnosis, 75% of patients with HIV will visit an emergency department (ED). Withthis in mind, the 2006 CDC guidelines recommended rapid routine opt-out HIVscreening in emergency departments [ED] for patients age 13-64. EDs now account for8% of testing venues but 29.9% of all tests and 32% of all HIV diagnoses. However,the rate of informing patients of their positive result was 93% and only 78% werelinked, defined as a single appointment scheduled, to an HIV care provider.Additionally, only 34% of those identified seropositive in the ED are satisfied with theexperience. In this study, we sought to 1) determine current practice of physicians inregards to disclosure and linkage to care and 2) identify Barriers to best practices.

Methods: An extensive review of literature, centered on the categories of bestpractices identified in the 2006 and subsequent CDC guidelines, was performed and24 best practices identified. Then a series of structured interviews with 16 emergencyphysicians was performed. They compose half of the active staff, at a Level 1Trauma Center which performs universal screening with approximately 200 newdiagnoses annually. Physicians were asked to self-rate on frequency of performance as“2 - Always,” “1 - Sometimes,” “0- Never,” in regards to the best practices identified.

Annals of Emergency Medicine S73