Outpatient follow-up after pediatric surgery reduces emergency department visits and readmission rates

Abstract Five percent of the patient population accounts for 50% of U.S. healthcare expenditures. High-need, high-cost patients are medically complex for numerous reasons, often including behavioral health needs. Intensive outpatient care programs (IOCPs) are emerging, innovative clinics which provide patient-centered care leveraging multidisciplinary teams. The overarching goals of IOCPs are to reduce emergency department visits and hospitalizations (and related costs), and improve care continuity and patient outcomes. The purpose of this review was to examine the effectiveness of IOCPs on multiple outcomes to inform clinical care. A systematic search of the literature was conducted to identify articles. Six studies were included that varied in rigor of research design, analysis, and measurement of outcomes. Most studies reported results on healthcare utilization (n = 4) and costs (n = 3), with fewer reporting results on patient-reported and health-related outcomes (n = 2). Overall, there were decreasing trends in emergency department visits and hospitalizations. However, results on healthcare utilization varied based on time of follow-up, with shorter follow-up times yielding more significant results. Two of the three studies that evaluated costs found significant reductions associated with IOCPs, and the third was cost-neutral. Two studies reported improvements in patient-reported outcomes (e.g., satisfaction, depression, and anxiety). Overall, these programs reported positive impacts on healthcare utilization and costs; however, few studies evaluated patient characteristics and behaviors (e.g., engagement in care) which may serve as key mechanisms of program effectiveness. Future research should examine patient characteristics, behaviors, and clinic engagement metrics to inform clinical practice.

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P143: A prospective cohort study characterizing 30-day recurrent emergency department visits for hyperglycemia

CJEM ◽

10.1017/cem.2019.334 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S116

Author(s):

J. Yan ◽

D. Azzam ◽

M. Columbus ◽

K. Van Aarsen

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Diabetes Management ◽

Care Delivery ◽

Tertiary Care ◽

Emergency Department Visits ◽

Local Health

Introduction: Hyperglycemic emergencies, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), often recur in patients who have poorly controlled diabetes. Identification of those at risk for recurrent hyperglycemia visits may improve health care delivery and reduce ED utilization for these patients. The objective of this study was to prospectively characterize patients re-presenting to the emergency department (ED) for hyperglycemia within 30 days of an initial ED visit. Methods: This is a prospective cohort study of patients ≥18 years presenting to two tertiary care EDs (combined annual census 150,000 visits) with a discharge diagnosis of hyperglycemia, DKA or HHS from Jul 2016-Nov 2018. Trained research personnel collected data from medical records, telephoned patients at 10-14 days after the ED visit for follow-up, and completed an electronic review to determine if patients had a recurrent hyperglycemia visit to any of 11 EDs within our local health integration network within 30 days of the initial visit. Descriptive statistics were used where appropriate to summarize the data. Results: 240 patients were enrolled with a mean (SD) age of 53.9 (18.6) years and 126 (52.5%) were male. 77 (32.1%) patients were admitted from their initial ED visit. Of the 237 patients (98.8%) with 30-day data available, 55 (23.2%) had a recurrent ED visit for hyperglycemia within this time period. 21 (8.9%) were admitted on this subsequent visit, with one admission to intensive care and one death within 30 days. For all patients who had a recurrent 30-day hyperglycemia visit, 22/55 (40.0%) reported having outpatient follow-up with a physician for diabetes management within 10-14 days of their index ED visit. 7/21 (33.3%) patients who were admitted on the subsequent visit had received follow-up within the same 10-14 day period. Conclusion: This prospective study builds on our previous retrospective work and describes patients who present recurrently for hyperglycemia within 30 days of an index ED visit. Further research will attempt to determine if access to prompt follow-up after discharge can reduce recurrent hyperglycemia visits in patients presenting to the ED.

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Impact of a Student Pharmacist Pilot Focused on the Transitions of Care Process From Emergency Department Visits to Family Medicine Follow-Up in a Rural Patient Setting

Journal of Pharmacy Practice ◽

10.1177/0897190020905468 ◽

2020 ◽

pp. 089719002090546

Author(s):

Christina E. DeRemer ◽

Shannon R. Lyons ◽

Emily J. Harman ◽

Karina Quinn ◽

Jason Konopack

Keyword(s):

Emergency Department ◽

Family Medicine ◽

Care Management ◽

Transitional Care ◽

Emergency Department Visits ◽

Care Process ◽

Emergency Department Utilization ◽

Primary Physician ◽

Rural Family

Introduction: Few would argue that emergency department utilization volumes do not tax the health system. Currently, there is not a process defined by Centers for Medicare and Medicaid Services for transitioning this patient population back to their primary physicians following emergency department visits. Resource limitations in a rural family medicine setting create barriers to dedicate focus on this important transitional care management from urgent care visits to primary care office. Objective: To describe a novel pilot process for transitional care management from the emergency department utilizing pharmacy student extenders to overcome resource limitation at a rural family medicine clinic and establish follow-up primary physician contact. Methods: From a master list provided, student pharmacists proactively telephoned patients and reviewed medication changes while assisting with scheduling follow-up appointments at the patient’s primary physician clinic. Results: The result of these efforts increased the communication with patients and resulted in a 26% (10/38) increase in follow-up appointments scheduled with a total increase of an additional 7 patients adhering to follow-up transitional appointment. Conclusion: This approach utilizing student extenders is a feasible and sustainable process that can increase patient contact when resources are limited, while serving as an educational tool for next generation providers.

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