|H&HN Daily RSS|
2 Ways to Fight ED Misuse — and Win
|By Paul Barr
H&HN Senior Writer
|October 16, 2013|
RWJF projects demonstrate successful ways to encourage appropriate use of emergency departments.
Emergency department misuse by patients is one of those problems that seem to repel any effort to find solutions.
Despite the high costs of treating patients for such nonemergency issues as a sore throat or a sore back in the ED, American patients just can't seem to break the habit.
But there are more signs that it is possible to reduce the number of inappropriate visits to the emergency department, and it can be done partly by using low-tech approaches.
Good news recently came out of ED-focused projects that are part of the Aligning Forces for Quality initiative backed by the Robert Wood Johnson Foundation.
After talking with some of the people working on two of the projects, I was encouraged about the future given that their success seems to be repeatable in other communities.
The Greater Detroit Area Health Council headed up an initiative with an independent practice association to reduce the number of visits to the ED for primary care problems to 7.3 visits per 1,000 insured patients in 2010 from 49 per 1,000 over the same four months in 2009.
The pilot achieved success by emphasizing "soft, yet purposeful changes," says Jenifer Hughes, executive vice president with Administrative Network Inc., which manages the daily operations of the IPA, Oakland Southfield Physicians.
The project focused on getting the word out to patients that their primary care doctors were available for such things as same-day appointments and consultation and visits after hours, times when they might have thought about going to the ED.
The project first had to ensure that the primary care physicians were, indeed, available. Getting the physicians in the IPA to cooperate was not difficult, Hughes says. "They don’t want their patients going into the ER if at all possible," Hughes says. The Detroit Council is now trying to expand the program far beyond the 26 doctors in the pilot.
In Milwaukee, a regional coalition of health systems, federally qualified health centers and government entities, was created to help Medicaid and uninsured patients. "We wanted to identify those with the greatest need of connecting with a medical home," says Betty Ragalie, project director for the coalition, called the Milwaukee Health Care Partnership. Within that group, the project focused on ensuring that there was the needed primary care follow-up after an ED visit.
The coalition worked to standardize case management at participating EDs, a difficult task because of the variation in resources at the hospitals, says Chris Decker, M.D., medical director for Froedtert Hospital and associate professor of emergency medicine at Medical College of Wisconsin.
Among those patients who kept their first primary care follow-up visit, there was a 44 percent decrease in ED use, comparing the six months before and after the appointment.
A key element of the program is the use of a health information exchange to track primary care for those patients, which has now become a vital tool to manage care at the community level, Decker says. The population of Medicaid and uninsured patients can be studied across demographic or clinical traits to find areas in which improvement is needed the most.
Next on the docket are patients within the scope of being on Medicaid or uninsured who are superutilizers of care, Ragalie says.
I'm guessing there are other such projects achieving similar success.
The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.