The Changing Landscape of America’s Health Care System and the Value of Emergency Medicine

Sasson, Comilla; Wiler, Jennifer L.; Haukoos, Jason S.; Sklar, David P.; Kellermann, Arthur L.; Beck, Dennis; Urbina, Chris; Heilpern, Kathryn; Magid, David J.

doi:10.1111/j.1553-2712.2012.1446.x

Cited by 13 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[41][42][43] However, as our study demonstrates, the reality is that ED visits after acute hospitalizations are commonplace, frequently the source of readmissions, and highly variable across institutions.…”

Section: Discussionmentioning

confidence: 89%

Emergency Department Visits After Surgery Are Common For Medicare Patients, Suggesting Opportunities To Improve Care

et al. 2013

View full text Add to dashboard Cite

Considerable attention is being paid to hospital readmission as a marker of poor postdischarge care coordination. However, little is known about another potential marker: emergency department (ED) use. We examined ED visits for Medicare patients within thirty days of discharge for six common inpatient surgeries. We found that these visits were widespread and showed extensive variation across facilities. For example, 17.3 percent of these patients experienced at least one ED visit within the postdischarge period, and 4.4 percent of patients had multiple ED visits. Among those patients who were readmitted, 56.5 percent were readmitted from the ED. There was substantial variation-as much as fourfold-in hospital-level ED use for these patients across all six procedures. The variation might signify a failure in upstream coordination of care and therefore might represent a novel hospital quality indicator. In addition, the postdischarge ED visit is an opportunity to ensure that care is properly coordinated and is the last best chance to avoid preventable readmissions.

show abstract

Section: Discussionmentioning

confidence: 89%

Emergency Department Visits After Surgery Are Common For Medicare Patients, Suggesting Opportunities To Improve Care

et al. 2013

View full text Add to dashboard Cite

show abstract

“…As more institutions move toward fully integrated models such as accountable care organizations, population‐based health models, and ESRD Seamless Care Organizations, healthcare systems need to become more cohesive and improve patient care delivery, including better coordination of outpatient visits, postoperative discharge communication, and patient education. While 30‐day readmissions have recently been targeted as a quality improvement measure by CMS, ED use has not yet become a national focus . However, the potential for inclusion of ED visits as a quality of care metric and associated reimbursement incentives will likely be significant drivers of systems and processes innovation.…”

Section: Discussionmentioning

confidence: 99%

Emergency department use among kidney transplant recipients in the United States

Lovasik

Zhang

Hockenberry

et al. 2018

American Journal of Transplantation

View full text Add to dashboard Cite

Patients with end-stage renal disease use the emergency department (ED) at a 6-fold higher rate than do other US adults. No national studies have described ED use rates among kidney transplant (KTx) recipients, and the factors associated with higher ED use. We examined a cohort of 132 725 adult KTx recipients in the United States Renal Data System (2005-2013). Data on ED visits, hospitalization, and outpatient nephrology visits were obtained from Medicare claims databases. Nearly half (46.1%) of KTx recipients had at least one ED visit (1.61 ED visits/patient-year [PY]), and 39.7% of ED visits resulted in hospitalization in the first year posttransplantation. ED visit rate was high in the first 30 days (5.26 visits/PY) but declined substantially thereafter (1.81 visits/PY in months 1-3; 1.13 visits/PY in months 3-12 posttransplantation). ED visit rates were higher in the first 30 days versus rates for dialysis patients but less than half the rate thereafter. Female sex, public insurance, medical comorbidities, longer pretransplantation dialysis vintage, and delayed graft function were associated with higher ED use in the first year post-KTx. Policies and strategies addressing potentially preventable ED visits should be promoted to help improve patient care and increase efficient use of ED resources.

show abstract

“…As health care policymakers seek to improve patient outcomes and reduce health care costs, research is needed to understand patient factors associated with high utilization of emergency health services . Studies indicate increased demand for both emergency medical services (EMS) and emergency department (ED) care in recent years .…”

Section: Patient Factors Associated With Frequent Use Of Edsmentioning

confidence: 99%

Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

et al. 2013

View full text Add to dashboard Cite

Objectives To optimize healthcare utilization, health outcomes, and costs, research is needed to improve an understanding of frequent users of emergency health services. Frequent use of emergency services is associated with high costs of healthcare and may be indicative of challenges accessing, or poor outcomes of, healthcare. We identified patient demographics and health factors related to frequent use of the emergency medical services (EMS) system of a mid-sized city. Study findings will aid in the development of targeted interventions to improve population health. Methods We reviewed 9-1-1 call dispatch data and Baltimore City Fire Department EMS records in 2008–10. Frequent use was defined as six or more EMS incidents in the 23 month period. Analyses used census data to compare demographics of EMS users to their population distribution; and examined differences in demographics and health problems of frequent EMS users compared to non-frequent users. Results Frequent EMS users (n=1,969) had a range of 6–199 EMS incidents (mean 11.2) during the observation period; and though they accounted for only 1.5% of EMS users, they were involved in 12.0% of incidents. Frequent users, as compared to non-frequent users and to the population, were more likely to be male, African American, or 45 years or older. Of frequent users, the modal age group was 45–54 years, accounting for 29.7% of frequent users, which represented twice this age group’s population distribution. Furthermore, this age group had the greatest overrepresentation of males (63.0% of frequent users), and was the peak age group for substance abuse related incidents (28.0% of frequent users’ incidents in this age group). Frequent users compared to non-frequent users had lower levels of trauma related incidents (5.1% versus 16.7%) and higher levels of medical incidents (94.8% versus 82.9%). As proportions of EMS incidents among frequent versus non-frequent users, respiratory, mental health, and seizure related incidents were highest in the youngest age groups; and substance abuse related incidents were highest in those middle aged (35–44 years and 45–54 years). Of health problems, behavioral health (mental health or substance use) problems most contributed to frequent EMS use (23.4% of frequent users’ incidents). Across all incidents, 65.8% of frequent users had an indication of behavioral health problems, representing a 6.6-fold higher odds than non-frequent users (22.5%). Frequent compared to non-frequent users also had higher levels of select chronic conditions (diabetes: 39.9% vs. 14.6%, respectively; asthma: 40.9% vs. 13.4%; and HIV: 9.1% vs. 2.4%), with unadjusted odds almost 4 to 7 times higher. Conclusions The study findings revealed the major role of chronic somatic and behavioral health problems in frequent EMS use; and that rates of frequent use were highest among those middle aged, African American, and male. The results suggest the need for coordination of EMS with community-based, integrated medical and behavioral health services to impro...

show abstract

The Changing Landscape of America’s Health Care System and the Value of Emergency Medicine

Cited by 13 publications

References 31 publications

Emergency Department Visits After Surgery Are Common For Medicare Patients, Suggesting Opportunities To Improve Care

Emergency Department Visits After Surgery Are Common For Medicare Patients, Suggesting Opportunities To Improve Care

Emergency department use among kidney transplant recipients in the United States

Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

Contact Info

Product

Resources

About