![]() ![]() We also compared preintervention high-users with new high-users of the postintervention period. Preintervention period patients, classified into ED high-users and occasional users, were studied for their mean annual visit rates and emergency severity, before and after the clinic start date. We studied adult ED patients’ visit patterns at the study hospital before and after implementation of a primary care intervention at a nonprofit urban hospital in South Carolina. The teaching hospital ED is typically overcrowded, known for its long ED waiting time. In the hospital vicinity, there are 2 other functioning EDs-one about 3 miles away at a county nonprofit hospital that serves as a teaching hospital for the University of South Carolina School of Medicine, and another at a nonprofit secular hospital in an adjacent county about 8 miles away in a different direction. The hospital is located in the inner-city neighborhood of Columbia, South Carolina, with pockets of minority- and poor-population concentration. This is a retrospective, observational study of one nonprofit, religious missionary hospital’s attempt to reduce low-severity ED visits through a primary care intervention. 6, 9 We used a before-after, observational cohort study design to examine the impact of free primary care access via an in-hospital primary care clinic on annual ED visit frequency and mean emergency severity of adult high-users. 6 - 8 Suboptimal outcomes noted were delayed life-saving care (eg, pneumonia, myocardial infarction), increased mortality, and increased hospital-acquired infection rates. The Society for Academic Emergency Medicine’s ED Crowding Task Force noted that ED crowding has resulted in several adverse impacts on patient outcomes related to patient safety, care timeliness, patient centeredness, efficiency, effectiveness, and equity. 2 These developments have led to the current ED capacity crisis, requiring evidence-based initiatives to reduce nonemergent ED visits. 4, 5 Since 2003, crowding has been aggravated by a new role served by EDs, as intermediate care zones (Observational Units) to preempt medically unnecessary inpatient admissions. 3 ED crowding steadily increased since 1997 through 2007, partly due to ED closures exceeding new EDs opened by 23.7%, while ED visit volumes increased 30%. In 2011, uninsured patients accounted for 16% of 131 million ED visits, nationwide. 1 - 3 However, EDs also present financial and medical resource challenges, being mandated to provide care to all patients under the Emergency Medical Treatment and Active Labor Act. About 14.7% of ED visits end in inpatient admission. ![]() ![]() The observed reductions in overall ED visit rates, particularly low-severity visits highest reductions observed among high-users and the top quartile of occasional users and the pattern of changes in emergency severity support a positive impact of the primary care intervention.Įmergency departments (EDs) are mission-critical for hospitals, and a key source of inpatient admissions, accounting for 50% of all inpatient admissions nationally in 2011. Pre- and post-intervention sample demographics and comorbidities were similar. Upon classifying preintervention high-users by emergency severity, postintervention mean ESI increased 24.5% among the lowest ESI quartile, and decreased 12.2% among the top quartile. ![]() Subgroup analysis of medically uninsured high-users showed similar results. Visit rates of the top quartile of occasional users also declined. Postintervention, the visit rates of new high-users were lower (lowest and top quartile rates, 0.6 and 3.23) than preintervention high-users’ rates in the preintervention period. High-users’ mean annual visit rates were 5.43 (top quartile) and 0.94 (bottom quartile) preintervention, versus 3.21 and 1.11, respectively, for returning high-users, postintervention (all P <. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. We compared pre- versus post-mean annual visit rates and discharge emergency severity index (ESI triage and resource use–based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) and occasional users. We studied adult ED visits during August 16, 2009-Aug(preintervention) and August 16, 2011-Aug(postintervention). This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. Reducing avoidable emergency department (ED) visits is an important health system goal. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |