{"id":"https://openalex.org/W2105922258","doi":"https://doi.org/10.1377/hlthaff.2009.1026","title":"Where Americans Get Acute Care: Increasingly, It\u2019s Not At Their Doctor\u2019s Office","display_name":"Where Americans Get Acute Care: Increasingly, It\u2019s Not At Their Doctor\u2019s Office","publication_year":2010,"publication_date":"2010-09-01","ids":{"openalex":"https://openalex.org/W2105922258","doi":"https://doi.org/10.1377/hlthaff.2009.1026","mag":"2105922258","pmid":"https://pubmed.ncbi.nlm.nih.gov/20820017"},"language":"en","primary_location":{"id":"doi:10.1377/hlthaff.2009.1026","doi":"https://doi.org/10.1377/hlthaff.2009.1026","is_oa":false,"landing_page_url":"https://doi.org/10.1377/hlthaff.2009.1026","pdf_url":null,"source":{"id":"https://openalex.org/S4210185023","display_name":"Health Affairs","issn_l":"0278-2715","issn":["0278-2715","1544-5208","2694-233X"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":["anvur-scientific","dongbi-a","doyens","fnege-2","jufo-2","medline","norway-1","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315983","host_organization_name":"Project HOPE","host_organization_lineage":["https://openalex.org/P4310315983"],"host_organization_lineage_names":["Project HOPE"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Affairs","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5015203505","display_name":"Stephen R. Pitts","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I150468666","display_name":"Emory University","ror":"https://ror.org/03czfpz43","country_code":"US","type":"education","lineage":["https://openalex.org/I150468666"]},{"id":"https://openalex.org/I2800194297","display_name":"Emory University Hospital Midtown","ror":"https://ror.org/02aknh966","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I132943300","https://openalex.org/I150468666","https://openalex.org/I2800194297"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Stephen R. Pitts","raw_affiliation_strings":["Stephen R. Pitts ( ) is an associate professor of medicine in the Department of Emergency Medicine, School of Medicine, Emory University, and a staff physician at Emory University Hospital Midtown, in Atlanta, Georgia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Stephen R. Pitts ( ) is an associate professor of medicine in the Department of Emergency Medicine, School of Medicine, Emory University, and a staff physician at Emory University Hospital Midtown, in Atlanta, Georgia","institution_ids":["https://openalex.org/I150468666","https://openalex.org/I2800194297"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5050023442","display_name":"Emily R. Carrier","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210089676","display_name":"Center for Studying Health System Change","ror":"https://ror.org/0065kgn45","country_code":"US","type":"other","lineage":["https://openalex.org/I4210089676"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Emily R. Carrier","raw_affiliation_strings":["Emily R. Carrier is a senior health researcher at the Center for Studying Health System Change, in Washington, D.C"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Emily R. Carrier is a senior health researcher at the Center for Studying Health System Change, in Washington, D.C","institution_ids":["https://openalex.org/I4210089676"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5021233149","display_name":"Eugene C. Rich","orcid":"https://orcid.org/0000-0003-4973-8607","observed_orcids":["https://orcid.org/0000-0003-4973-8607"]},"institutions":[{"id":"https://openalex.org/I66531908","display_name":"Mathematica Policy Research","ror":"https://ror.org/02403vr89","country_code":"US","type":"facility","lineage":["https://openalex.org/I66531908"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Eugene C. Rich","raw_affiliation_strings":["Eugene C. Rich is a senior fellow at Mathematica Policy Research, in Washington"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Eugene C. Rich is a senior fellow at Mathematica Policy Research, in Washington","institution_ids":["https://openalex.org/I66531908"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5109571602","display_name":"Arthur L. Kellermann","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1309849503","display_name":"RAND Corporation","ror":"https://ror.org/00f2z7n96","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I1309849503"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Arthur L. Kellermann","raw_affiliation_strings":["Arthur L. Kellermann is a senior principal researcher and holds the Paul O\u2019Neill Alcoa Chair in Policy Analysis at the RAND Corporation, in Arlington, Virginia"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Arthur L. Kellermann is a senior principal researcher and holds the Paul O\u2019Neill Alcoa Chair in Policy Analysis at the RAND Corporation, in Arlington, Virginia","institution_ids":["https://openalex.org/I1309849503"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":5,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":19.3404,"has_fulltext":false,"cited_by_count":278,"citation_normalized_percentile":{"value":0.99482759,"is_in_top_1_percent":true,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":97,"max":100},"biblio":{"volume":"29","issue":"9","first_page":"1620","last_page":"1629"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11095","display_name":"Emergency and Acute Care Studies","score":0.7724999785423279,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11095","display_name":"Emergency and Acute Care Studies","score":0.7724999785423279,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11590","display_name":"Primary Care and Health Outcomes","score":0.12330000102519989,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.0934000015258789,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/acute-care","display_name":"acute care","score":0.8610000014305115},{"id":"https://openalex.org/keywords/primary-care","display_name":"primary care","score":0.5109999775886536},{"id":"https://openalex.org/keywords/emergency-department","display_name":"emergency department","score":0.7760000228881836},{"id":"https://openalex.org/keywords/general-practitioners","display_name":"general practitioners","score":0.5830000042915344},{"id":"https://openalex.org/keywords/health-care-access","display_name":"health care access","score":0.5669999718666077},{"id":"https://openalex.org/keywords/uninsured-patients","display_name":"uninsured patients","score":0.8159999847412109},{"id":"https://openalex.org/keywords/affordable-care-act","display_name":"Affordable Care Act","score":0.9509999752044678},{"id":"https://openalex.org/keywords/patient-centered-medical-home","display_name":"patient-centered medical home","score":0.9950000047683716},{"id":"https://openalex.org/keywords/accountable-care-organizations","display_name":"accountable care organizations","score":1.0},{"id":"https://openalex.org/keywords/health-care-reform","display_name":"health care reform","score":0.7480000257492065},{"id":"https://openalex.org/keywords/outpatient-care","display_name":"outpatient care","score":0.367000013589859}],"concepts":[{"id":"https://openalex.org/C2781385661","wikidata":"https://www.wikidata.org/wiki/Q4677918","display_name":"Acute care","level":3,"score":0.7066542506217957},{"id":"https://openalex.org/C85079727","wikidata":"https://www.wikidata.org/wiki/Q3560114","display_name":"Quarter (Canadian coin)","level":2,"score":0.675976037979126},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6668443083763123},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5730536580085754},{"id":"https://openalex.org/C2780724011","wikidata":"https://www.wikidata.org/wiki/Q1295316","display_name":"Emergency department","level":2,"score":0.5573933720588684},{"id":"https://openalex.org/C124306116","wikidata":"https://www.wikidata.org/wiki/Q2512965","display_name":"Ambulatory care","level":3,"score":0.5281698107719421},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.4803706109523773},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.47865235805511475},{"id":"https://openalex.org/C2778584109","wikidata":"https://www.wikidata.org/wiki/Q60603744","display_name":"Health care reform","level":4,"score":0.43258392810821533},{"id":"https://openalex.org/C3018838755","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Medical care","level":2,"score":0.430203914642334},{"id":"https://openalex.org/C2776643233","wikidata":"https://www.wikidata.org/wiki/Q1414593","display_name":"Patient Protection and Affordable Care Act","level":4,"score":0.42768359184265137},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.38076165318489075},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.3099589943885803},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.2509235441684723},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.23002654314041138},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.11300218105316162},{"id":"https://openalex.org/C95457728","wikidata":"https://www.wikidata.org/wiki/Q309","display_name":"History","level":0,"score":0.0},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.0},{"id":"https://openalex.org/C166957645","wikidata":"https://www.wikidata.org/wiki/Q23498","display_name":"Archaeology","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D004636","descriptor_name":"Emergency Service, Hospital","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D006297","descriptor_name":"Health Services Accessibility","qualifier_ui":"Q000331","qualifier_name":"legislation & jurisprudence","is_major_topic":false},{"descriptor_ui":"D006297","descriptor_name":"Health Services Accessibility","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010342","descriptor_name":"Patient Acceptance of Health Care","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D010818","descriptor_name":"Practice Patterns, Physicians'","qualifier_ui":"Q000639","qualifier_name":"trends","is_major_topic":false},{"descriptor_ui":"D010818","descriptor_name":"Practice Patterns, Physicians'","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D011785","descriptor_name":"Quality Assurance, Health Care","qualifier_ui":"Q000331","qualifier_name":"legislation & jurisprudence","is_major_topic":false},{"descriptor_ui":"D011785","descriptor_name":"Quality Assurance, Health Care","qualifier_ui":"Q000592","qualifier_name":"standards","is_major_topic":false},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D018166","descriptor_name":"Health Care Reform","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D018802","descriptor_name":"Patient-Centered Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D019538","descriptor_name":"Health Care Surveys","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D058006","descriptor_name":"General Practice","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true}],"locations_count":5,"locations":[{"id":"doi:10.1377/hlthaff.2009.1026","doi":"https://doi.org/10.1377/hlthaff.2009.1026","is_oa":false,"landing_page_url":"https://doi.org/10.1377/hlthaff.2009.1026","pdf_url":null,"source":{"id":"https://openalex.org/S4210185023","display_name":"Health Affairs","issn_l":"0278-2715","issn":["0278-2715","1544-5208","2694-233X"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":["anvur-scientific","dongbi-a","doyens","fnege-2","jufo-2","medline","norway-1","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315983","host_organization_name":"Project HOPE","host_organization_lineage":["https://openalex.org/P4310315983"],"host_organization_lineage_names":["Project HOPE"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health Affairs","raw_type":"journal-article"},{"id":"pmid:20820017","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/20820017","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Health affairs (Project Hope)","raw_type":"Journal Article"},{"id":"mag:2294705503","doi":null,"is_oa":false,"landing_page_url":"https://econpapers.repec.org/RePEc:mpr:mprres:9750892f48024a5090edb957963f3408","pdf_url":null,"source":{"id":"https://openalex.org/S4306401271","display_name":"RePEc: Research Papers in Economics","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I77793887","host_organization_name":"Federal Reserve Bank of St. Louis","host_organization_lineage":["https://openalex.org/I77793887"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"RePEc: Research Papers in Economics","raw_type":null},{"id":"mag:3144897051","doi":null,"is_oa":false,"landing_page_url":"https://ideas.repec.org/p/mpr/mprres/9750892f48024a5090edb957963f3408.html","pdf_url":null,"source":{"id":"https://openalex.org/S2764647102","display_name":"Mathematica Policy Research Reports","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Mathematica Policy Research Reports","raw_type":null},{"id":"pmh:oai:RePEc:mpr:mprres:9750892f48024a5090edb957963f3408","doi":null,"is_oa":false,"landing_page_url":"http://content.healthaffairs.org/cgi/content/abstract/29/9/1620","pdf_url":null,"source":{"id":"https://openalex.org/S4306401271","display_name":"RePEc: Research Papers in Economics","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I77793887","host_organization_name":"Federal Reserve Bank of St. Louis","host_organization_lineage":["https://openalex.org/I77793887"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"preprint"}],"best_oa_location":null,"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.8560000061988831,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[],"awards":[{"id":"https://openalex.org/G6148270917","display_name":null,"funder_award_id":"CDC T01 CD000146","funder_id":"https://openalex.org/F4320332505","funder_display_name":"U.S. Public Health Service"}],"funders":[{"id":"https://openalex.org/F4320332505","display_name":"U.S. Public Health Service","ror":"https://ror.org/05xf94514"}],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":31,"referenced_works":["https://openalex.org/W640553068","https://openalex.org/W1585636453","https://openalex.org/W1978192514","https://openalex.org/W1978239150","https://openalex.org/W1979365938","https://openalex.org/W1980564752","https://openalex.org/W1985778016","https://openalex.org/W1996619532","https://openalex.org/W2018757930","https://openalex.org/W2021737457","https://openalex.org/W2024061754","https://openalex.org/W2025213073","https://openalex.org/W2026611607","https://openalex.org/W2031766987","https://openalex.org/W2034681264","https://openalex.org/W2046702626","https://openalex.org/W2055476904","https://openalex.org/W2057394442","https://openalex.org/W2060303240","https://openalex.org/W2074042072","https://openalex.org/W2083503605","https://openalex.org/W2089466082","https://openalex.org/W2092751924","https://openalex.org/W2109419457","https://openalex.org/W2113721982","https://openalex.org/W2140682762","https://openalex.org/W2145244402","https://openalex.org/W2167943710","https://openalex.org/W2509711324","https://openalex.org/W4253429216","https://openalex.org/W4388366552"],"related_works":["https://openalex.org/W64462442","https://openalex.org/W2055849505","https://openalex.org/W2332102869","https://openalex.org/W2327945328","https://openalex.org/W161085288","https://openalex.org/W2002281412","https://openalex.org/W2314951207","https://openalex.org/W2914326292","https://openalex.org/W4205229895","https://openalex.org/W2766610519"],"abstract_inverted_index":{"Historically,":[0],"general":[1],"practitioners":[2],"provided":[3],"first-contact":[4],"care":[5,68,98,121],"in":[6,83,116],"the":[7,16,78,84,117],"United":[8],"States.":[9],"Today,":[10],"however,":[11],"only":[12],"42":[13],"percent":[14,55],"of":[15,56,65,74],"354":[17],"million":[18],"annual":[19],"visits":[20,76],"for":[21,24,110],"acute":[22,67,106,120],"care--treatment":[23],"newly":[25],"arising":[26],"health":[27],"problems--are":[28],"made":[29,37],"to":[30,38,102,105,114],"patients'":[31],"personal":[32],"physicians.":[33],"The":[34,108],"rest":[35],"are":[36,58,100],"emergency":[39,59],"departments":[40,48],"(28":[41],"percent),":[42,45],"specialists":[43],"(20":[44],"or":[46],"outpatient":[47],"(7":[49],"percent).":[50],"Although":[51],"fewer":[52],"than":[53,72],"5":[54],"doctors":[57],"physicians,":[60],"they":[61],"handle":[62],"a":[63],"quarter":[64],"all":[66],"encounters":[69],"and":[70,87,96],"more":[71],"half":[73],"such":[75],"by":[77],"uninsured.":[79],"Health":[80],"reform":[81,111],"provisions":[82],"Patient":[85],"Protection":[86],"Affordable":[88],"Care":[89],"Act":[90],"that":[91],"advance":[92],"patient-centered":[93],"medical":[94],"homes":[95],"accountable":[97],"organizations":[99],"intended":[101],"improve":[103],"access":[104],"care.":[107],"challenge":[109],"will":[112],"be":[113],"succeed":[115],"current,":[118],"complex":[119],"landscape.":[122]},"counts_by_year":[{"year":2026,"cited_by_count":7},{"year":2025,"cited_by_count":7},{"year":2024,"cited_by_count":7},{"year":2023,"cited_by_count":5},{"year":2022,"cited_by_count":17},{"year":2021,"cited_by_count":10},{"year":2020,"cited_by_count":17},{"year":2019,"cited_by_count":24},{"year":2018,"cited_by_count":19},{"year":2017,"cited_by_count":20},{"year":2016,"cited_by_count":24},{"year":2015,"cited_by_count":25},{"year":2014,"cited_by_count":31},{"year":2013,"cited_by_count":31},{"year":2012,"cited_by_count":18}],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2016-06-24T00:00:00"}
