An Intervention Connecting Low-Acuity Emergency Department Patients With Primary Care: Effect on Future Primary Care Linkage

Doran, Kelly M.; Colucci, Ashley C.; Hessler, Robert; Ngai, Calvin K.; Williams, Nick; Wallach, Andrew; Tanner, Michael; Allen, Machelle; Goldfrank, Lewis R.; Wall, Stephen P.

doi:10.1016/j.annemergmed.2012.10.021

Cited by 43 publications

(31 citation statements)

References 45 publications

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“…Surveys of older patients presenting to EDs with lower clinical urgency suggest that perception regarding timely access to specialist care is also an important consideration in this age group 20 21. Trials investigating co-located primary care centres and urgent care telephone triage services have only had limited success in reducing low-acuity ED presentations and in some instances have been associated with increased ED attendances 22 23. In addition, the proposed Federal Government ‘GP co-payment’ policy by further limiting access to appropriate primary healthcare is likely to have a detrimental impact on the health system by increasing low-acuity demand at public hospital EDs 24…”

Section: Discussionmentioning

confidence: 99%

Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area

et al. 2014

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“…The study found no reductions in ED visits at 12-month follow-up comparing intervention to usual care groups (adjusted mean difference -0.23; 95% confidence interval -0.61 to 0.16) and did not assess hospitalization rates or mortality. 46 Five studies examined the effect that imposing ED copayments at the visit had on ED use. The largest study examined the effect of ED copayments for Kaiser Permanente members with Medicare or commercial insurance.…”

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confidence: 99%

“…Investigators referred eligible patients to an onsite primary care clinic (intervention) or to an ED-based urgent care clinic (usual care) according to which site (urgent care versus onsite primary care) would result in the least delay. 46 A secondary comparison group included ED patients who met eligibility criteria but who had a primary care provider outside the study hospital. The study found no reductions in ED visits at 12-month follow-up comparing intervention to usual care groups (adjusted mean difference -0.23; 95% confidence interval -0.61 to 0.16) and did not assess hospitalization rates or mortality.…”

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confidence: 99%

The Effectiveness of Emergency Department Visit Reduction Programs: A Systematic Review

Raven

Kushel

et al. 2016

Annals of Emergency Medicine

109

119

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Twitter: @mravenEM.Study objective: Previous reviews of emergency department (ED) visit reduction programs have not required that studies meet a minimum quality level and have therefore included low-quality studies in forming conclusions about the benefits of these programs. We conduct a systematic review of ED visit reduction programs after judging the quality of the research. We aim to determine whether these programs are effective in reducing ED visits and whether they result in adverse events. Methods:We identified studies of ED visit reduction programs conducted in the United States and targeted toward adult patients from January 1, 2003, to December 31, 2014. We evaluated study quality according to the Grading of Recommendations Assessment, Development, and Evaluation criteria and included moderate-to high-quality studies in our review. We categorized interventions according to whether they targeted high-risk or low-acuity populations. Results:We evaluated the quality of 38 studies and found 13 to be of moderate or high quality. Within these 13 studies, only case management consistently reduced ED use. Studies of ED copayments had mixed results. We did not find evidence for any increase in adverse events (hospitalization rates or mortality) from the interventions in either high-risk or low-acuity populations.Conclusion: High-quality, peer-reviewed evidence about ED visit reduction programs is limited. For most program types, we were unable to draw definitive conclusions about effectiveness. Future ED visit reduction programs should be regarded as demonstrations in need of rigorous evaluation.

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“…19 In our study, we used HIT to schedule a PCP appointment for the patient in real time, thereby both bypassing the phone queue and eliminating potential negative experiences new Medicaid patients may face when calling a PCP's office. While this intervention effectively closed the communication loop between the ED provider and the newly established PCP, we found that this system change was not enough to change patients' care-seeking behavior over the longer term.…”

Section: Discussionmentioning

confidence: 99%

Connecting Emergency Department Patients to Primary Care

Wexler

Hefner

Sieck

et al. 2015

The Journal of the American Board of Family Medicine

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Background: Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem because of cost. We developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients.Methods: Patients who presented to the ED without an identified primary care provider were randomized to the intervention (n ‫؍‬ 72) or comparison group (n ‫؍‬ 68) for a 12-month study designed to connect these patients to primary care offices. Evaluation was mixed quantitative/qualitative.Results: Significantly more intervention participants attended at least 1 primary care visit 3 months after the intervention (odds ratio [

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An Intervention Connecting Low-Acuity Emergency Department Patients With Primary Care: Effect on Future Primary Care Linkage

Cited by 43 publications

References 45 publications

Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area

Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area

The Effectiveness of Emergency Department Visit Reduction Programs: A Systematic Review

Connecting Emergency Department Patients to Primary Care

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