Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study
Reducing avoidable emergency department (ED) visits is an important health system goal. 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 h...
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Series: | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
Online Access: | https://doi.org/10.1177/0046958018763917 |
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doaj-a687a869d0904876920b151af4f3cdcd2020-11-25T03:24:03ZengSAGE PublishingInquiry: The Journal of Health Care Organization, Provision, and Financing0046-95801945-72432018-03-015510.1177/0046958018763917Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective StudyMeng-Han Tsai PhD, MHA0Sudha Xirasagar MBBS, PhD1Scott Carroll MD2Charles S. Bryan MD3Pamela J. Gallagher DBA, MBA, CPA4Kim Davis DO5Edward C. Jauch MD, MS6University of South Carolina, Columbia, USAUniversity of South Carolina, Columbia, USAProvidence Health, Columbia, SC, USAProvidence Health, Columbia, SC, USACommunity Hospital Corporation, Plano, TX, USAProvidence Health, Columbia, SC, USAMedical University of South Carolina, Charleston, USAReducing avoidable emergency department (ED) visits is an important health system goal. 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. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (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. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. 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 < .001). 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. Visit rates of the top quartile of occasional users also declined. Subgroup analysis of medically uninsured high-users showed similar results. 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. Pre- and post-intervention sample demographics and comorbidities were similar. 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.https://doi.org/10.1177/0046958018763917 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Meng-Han Tsai PhD, MHA Sudha Xirasagar MBBS, PhD Scott Carroll MD Charles S. Bryan MD Pamela J. Gallagher DBA, MBA, CPA Kim Davis DO Edward C. Jauch MD, MS |
spellingShingle |
Meng-Han Tsai PhD, MHA Sudha Xirasagar MBBS, PhD Scott Carroll MD Charles S. Bryan MD Pamela J. Gallagher DBA, MBA, CPA Kim Davis DO Edward C. Jauch MD, MS Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study Inquiry: The Journal of Health Care Organization, Provision, and Financing |
author_facet |
Meng-Han Tsai PhD, MHA Sudha Xirasagar MBBS, PhD Scott Carroll MD Charles S. Bryan MD Pamela J. Gallagher DBA, MBA, CPA Kim Davis DO Edward C. Jauch MD, MS |
author_sort |
Meng-Han Tsai PhD, MHA |
title |
Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study |
title_short |
Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study |
title_full |
Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study |
title_fullStr |
Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study |
title_full_unstemmed |
Reducing High-Users’ Visits to the Emergency Department by a Primary Care Intervention for the Uninsured: A Retrospective Study |
title_sort |
reducing high-users’ visits to the emergency department by a primary care intervention for the uninsured: a retrospective study |
publisher |
SAGE Publishing |
series |
Inquiry: The Journal of Health Care Organization, Provision, and Financing |
issn |
0046-9580 1945-7243 |
publishDate |
2018-03-01 |
description |
Reducing avoidable emergency department (ED) visits is an important health system goal. 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. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (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. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. 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 < .001). 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. Visit rates of the top quartile of occasional users also declined. Subgroup analysis of medically uninsured high-users showed similar results. 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. Pre- and post-intervention sample demographics and comorbidities were similar. 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. |
url |
https://doi.org/10.1177/0046958018763917 |
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