Date of Award

Fall 2016

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Robert J. Cramer

Committee Director

Bonnie Van Lunen

Committee Member

Muge Akpinar-Elci

Committee Member

Maureen Boshier


Even though emergency departments (EDs) were created to treat trauma and emergent cases, there has been an increase in emergency department (ED) utilization for non-emergent reasons over the past half of a century. As non-emergent utilization grows as a result of the ED becoming a prevalent substitute for primary care, overcrowding of the ED and increased wait times will continue. Additionally, unnecessary cost to both the ED and the patient will be incurred. Previous research has examined and determined various reasons and risk factors driving non-emergent ED use, among them the influence of living location and the number of non-emergent care resources within a location. However, living location and the number of non-emergent care sources has not been examined in regards to their influence on other previously established risk factors such as age, race, and having a chronic disease/illness. Examination of this influence will allow policymakers, hospital leadership, and government officials to better determine a solution to non-emergent ED use.

This study examines the influence of the constructs of the Aday-Andersen model on non-emergent ED utilization, as well as the influence of patient living location and the number of non-emergent care sources in a living location on the model constructs. Logistic regression was implemented to predict type of ED use in the 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient limited dataset. Overall, need for health care and predisposing factors were found to be most influential in driving ED use. This is contradictory to the original hypothesis stating that enabling resources and need would be the strongest predictors. Need remains the main driving factor in ED use for both rural living location and no non-emergent care sources. An increased likelihood for ethnic minorities to utilize the ED was also seen for these two moderators. The findings of this study reveal that not only is need the biggest driver for ED use, but also that the Behavioral Model of Health Services use may not be applicable for this type of health care. Additional health behavior theory analyses could provide further insight on the model’s applicability.