Decreasing Hospital Utilization of a High Risk Heart Failure Population in a Large Urban Accountable Care Organization: The Use of a Clinical Pharmacist, Serial Biomarkers, and Point of Care Ultrasound

Background Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilization have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or patient groups within the EDs. The purpose of this scoping review was to identify, summarize, and categorize the various types of non-ED-based interventions designed to reduce unnecessary visits to EDs. Methods This scoping review followed the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A comprehensive structured literature search was performed in the databases MEDLINE and Embase from 2008 to March 2024. The inclusion criteria covered studies reporting on interventions outside the ED that aimed to reduce ED visits. Two reviewers independently screened the records and categorized the included articles by intervention type, location, and population. Results Among the 15,324 screened records, we included 210 studies, comprising 183 intervention studies and 27 systematic reviews. In the primary studies, care coordination/case management or other care programs were the most commonly examined out of 15 different intervention categories. The majority of interventions took place in clinics or medical centers, in patients’ homes, followed by hospitals and primary care settings - and targeted patients with specific medical conditions. Conclusion A large number of studies have been published investigating interventions to mitigate the influx of patients to EDs. Many of these targeted patients with specific medical conditions, frequent users and high-risk patients. Further research is needed to address other high prevalent groups in the ED - including older adults and mental health patients (who are ill but may not need the ED). There is also room for further research on new interventions to reduce ED utilization in low-acuity patients and in the general patient population.

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Implementation of a Home Monitoring System for Heart Failure Patients: A Feasibility Study

Köhn

Haggard

Kreindler

et al. 2017

JMIR Res Protoc

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BackgroundImproving the management of patients with complex chronic disease is a substantial undertaking with the simultaneous goals of improving patient outcomes and controlling costs. Reducing avoidable hospitalization for such patients is a step toward both objectives. Some of the deterioration experienced in chronic disease patients occurs outside the view of their clinicians, and before the patient becomes overtly symptomatic. Home monitoring has been used for more than 20 years to detect deterioration earlier so that the patients could be treated before they became ill enough to require hospitalization. Patient participation is an important requirement for successful home monitoring. There has been some concern that patients would be unwilling or unable to engage in a program that collected multiple measurements. The Cedars-Sinai Cardiology Center provides a high-touch, intense management program for patients with congestive heart failure (CHF). A group of their patients were chosen to join a complex, multidevice home monitoring system to see whether such patients would find value in the additional effort.ObjectiveThe objective of our study was to determine whether patients already actively engaged in a high-touch intensive management program for CHF would take on the additional burden of a complex home monitoring effort.MethodsA total of 20 patients from the Cedars-Sinai group were enrolled in a monitoring program utilizing 5 different devices. Anonymous surveys were collected from the patients to assess their satisfaction with the program.ResultsIn total, 90% (18/20) completed the program, and 61% (11/20) submitted the survey. Among the 18 patients, overall compliance with the requested measurements was 70%. It was found that 73% (8/11) felt better about their health as a result of the program, whereas another 73% (8/11) believed that the care team now had a better picture of their health.ConclusionsSubstantial patient compliance and satisfaction can be achieved in a sophisticated home monitoring program.

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Decreasing Hospital Utilization of a High Risk Heart Failure Population in a Large Urban Accountable Care Organization: The Use of a Clinical Pharmacist, Serial Biomarkers, and Point of Care Ultrasound

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Usefulness of Serial Measurements of Inferior Vena Cava Diameter by Vscan TM to Identify Patients With Heart Failure at High Risk of Hospitalization

Usefulness of Serial Measurements of Inferior Vena Cava Diameter by Vscan TM to Identify Patients With Heart Failure at High Risk of Hospitalization

Non-emergency department (ED) interventions to reduce ED utilization: a scoping review

Implementation of a Home Monitoring System for Heart Failure Patients: A Feasibility Study

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