scholarly journals Reduced Emergency Department Utilization During the Early Phase of the COVID-19 Pandemic: Viral Fear or Lockdown Effect?

2020 ◽  
pp. 1-4
Author(s):  
Dennis G. Barten ◽  
Gideon H.P. Latten ◽  
Frits H.M. van Osch
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Early Phase ◽  
Emergency Department Utilization ◽  
Primary Care System ◽  
Chi Square ◽  
Frontline Workers ◽  
Admission Rates ◽  
Ed Visits ◽  
Care System

ABSTRACT Objective: Since the beginning of the coronavirus disease (COVID-19) pandemic, several frontline workers have expressed their concerns about reduced emergency department (ED) utilization. We aimed to examine the changes in ED utilization during the early phase of the COVID-19 pandemic, in a country with a well-developed primary care system. Methods: A retrospective analysis of ED utilization was performed in 3 Dutch hospitals during a 60-day period, starting on February 15, 2020. The identical period in 2019 was used as a reference. ED visits were labeled as COVID-related (defined as COVID-19 suspected) or non-COVID-related. Admission rates were compared using chi-square tests, and the reduction in ED visits was assessed descriptively. Results: During the study period, daily ED volume was 18% lower compared to that of 2019. ED utilization further declined (-29%) during lockdown. Combined admission rates were higher in 2020 compared to those in 2019 (P < 0.001), and they were higher for COVID-19 versus non-COVID-19 ED visits (P < 0.001). Conclusions: ED utilization was markedly reduced during the local rise of COVID-19 in a region with a well-developed primary care system and relatively low ED self-referral rates. Although it cannot directly be concluded from the findings of our study, this observation likely reflects a complex interaction between pure lockdown effects and viral fear, which warrants further research.

scholarly journals First and Second Wave Dynamics of Emergency Department Utilization during the COVID-19 Pandemic: a retrospective study

2021 ◽  
Author(s):  
Robi Dijk ◽  
Patricia Plaum ◽  
Stan Tummers ◽  
Frits van Osch ◽  
Dennis Barten ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urgent Care ◽  
Emergency Department Utilization ◽  
Reference Period ◽  
Wave Dynamics ◽  
Admission Rates ◽  
High Urgency ◽  
Ed Visits ◽  
Second Wave ◽  
Insight Into

Background: Since the COVID-19 pandemic, there has been a decrease in emergency department(ED) utilization. Although this has been thoroughly characterized for the first wave(FW), studies during the second wave(SW) are limited. We examined the changes in ED utilization between the FW and SW, compared to 2019 reference periods. Methods: We performed a retrospective analysis of ED utilization in 3 Dutch hospitals in 2020. The FW and SW (March until June and September until December, respectively) were compared to the reference periods in 2019. ED visits were labeled as (non)COVID suspected. Findings: During the FW and SW ED visits decreased by 20.3% and 15.3%, respectively, when compared to reference periods in 2019. During both waves high urgency visits significantly increased with 3.1% and 2.1%, and admission rates (ARs) increased with 5.0% and 10.4%. Trauma related visits decreased by 5.2% and 3.4%. During the SW we observed less COVID-related visits compared to the FW (4,407 vs 3,102 patients). COVID related visits were significantly more often in higher need of urgent care and ARs where at least 24.0% higher compared to non COVID visits. Interpretation: During both COVID-19 waves ED visits were significantly reduced, with the most distinct decline during the FW. ED patients were more often triaged as high urgent and the ARs were increased compared to the reference period in 2019, reflecting a high burden on ED resources. These findings indicate the need to gain more insight into motives of patients to delay or avoid emergency care during pandemics and prepare EDs for future pandemics.

Everyday J.

2020 ◽  
pp. 141-146
Author(s):  
Chadd K. Kraus
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Hospital Admission ◽  
Health Care Services ◽  
Medical Emergency ◽  
State Laws ◽  
Admission Rates ◽  
Care Services ◽  
Ed Visits

Commonly defined as having greater than four emergency department (ED) visits in a year, patients who are frequent users of the ED make up an estimated 3.5% to 10% of all ED visits and have been reported to account for nearly a third of all ED use. Frequent ED users have higher mortality, higher hospital admission rates, and higher use of all health care services, both specialty and primary care, compared to other patients using the ED. These patients should have the autonomy to access ED evaluation and care if he or she believes he or she has a medical emergency. This principle has been codified into both federal and many state laws protecting the “prudent layperson standard.” These patients should not be coerced to not seek ED care if the person believes he or she has an emergent condition.

scholarly journals Primary Care Comprehensiveness and Care Coordination in Robust Specialist Networks Results in Lower Emergency Department Utilization: A Network Analysis of Medicaid Physician Networks

2020 ◽  
Vol 11 ◽  
pp. 215013272092443
Author(s):  
Zhaowei She ◽  
Anne H. Gaglioti ◽  
Peter Baltrus ◽  
Chaohua Li ◽  
Miranda A. Moore ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Network Analysis ◽  
Care Coordination ◽  
Emergency Department Utilization ◽  
Network Characteristics ◽  
Ed Visits ◽  
Physician Networks ◽  
High Degree ◽  
The Impact

Background: Care coordination is an essential and difficult to measure function of primary care. Objective: Our objective was to assess the impact of network characteristics in primary/specialty physician networks on emergency department (ED) visits for patients with chronic ambulatory care sensitive conditions (ACSCs). Subjects and Measures: This cross-sectional social network analysis of primary care and specialty physicians caring for adult Medicaid beneficiaries with ACSCs was conducted using 2009 Texas Medicaid Analytic eXtract (MAX) files. Network characteristic measures were the main exposure variables. A negative binomial regression model analyzed the impact of network characteristics on the ED visits per patient in the panel. Results: There were 42 493 ACSC patients assigned to 5687 primary care physicians (PCPs) connected to 11 660 specialist physicians. PCPs whose continuity patients did not visit a specialist had 86% fewer ED visits per patient in their panel, compared with PCPs whose patients saw specialists. Among PCPs connected to specialists in the network, those with a higher number of specialist collaborators and those with a high degree of centrality had lower patient panel ED rates. Conclusions: PCPs providing comprehensive care (ie, without specialist consultation) for their patients with chronic ACSCs had lower ED utilization rates than those coordinating care with specialists. PCPs with robust specialty networks and a high degree of centrality in the network also had lower ED utilization. The right fit between comprehensiveness of primary care, care coordination, and adequate capacity of specialty availability in physician networks is needed to drive outcomes.

scholarly journals Approaches for Improving Health Equity: The Effect of The Gainesville Community Resource Paramedic Program on Reducing Emergency Department Utilization

2020 ◽  
Author(s):  
Andrew S Cistola ◽  
Ariella N Bak ◽  
Laura Guyer ◽  
Austin Reed ◽  
Ben Rooks ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Primary Care Providers ◽  
Emergency Department Utilization ◽  
Care Providers ◽  
Community Resource ◽  
Paired Samples ◽  
Before And After ◽  
Ed Visits ◽  
Student’S T

Abstract Background. The U.S. healthcare system has consistently struggled with inefficiencies in Emergency Department (ED) usage (Enard & Ganelin, 2013). Other studies have established that interventions focusing on care coordination are not able to reduce utilization (Finkelstein, 2020), and current ED reduction programs in the literature focus on establishing patients in primary care (Raven, 2016). In community paramedicine programs, paramedics collaborate with interdisciplinary partners to address the needs of patients outside of traditional health care settings. The Gainesville Community Resource Paramedic Program (Gainesville CRP) was implemented in 2017 to provide an intervention to address social determinants that primary care providers (PCP) cannot address. Methods. A Student’s t-test for paired samples was used to compare total ED visits as well as ED visits with and without hospital admission six months before and after program enrollment. Pearson’s correlation between final change in total ED visits and total PCP visits for pre-CRP, post-CRP, and full-CRP were calculated to determine if there was evidence for bias in utilization patterns. Results. Among program participants (n = 53), significant reductions were observed among total (mean = 2.94, p < 0.001), without admission (mean = 1.30, p = 0.006), and with admission (mean = 1.64, p = 0.002). Significant reductions were also found among selected demographics and morbidities. Reductions in total ED visits were not associated with visits to a PCP before, after, or throughout. Conclusions. Gainesville CRP was able to reduce ED visits independent of PCPs indicating that the approach could inform other ED diversion programs.

scholarly journals Estimating the Costs of Implementing Comprehensive Primary Care: A Narrative Review

2019 ◽  
Vol 6 ◽  
pp. 233339281984248
Author(s):  
Grant R. Martsolf ◽  
Ryan Kandrack ◽  
Mark W. Friedberg ◽  
Brian Briscombe ◽  
Peter S. Hussey ◽  
...  
Keyword(s):  
Primary Care ◽  
Narrative Review ◽  
Fee For Service ◽  
Primary Care System ◽  
High Functioning ◽  
Illness Burden ◽  
Care Practices ◽  
Primary Care Practices ◽  
Limited Generalizability ◽  
Care System

The performance of the any health-care system relies on a high-functioning primary care system. Increasing primary care practices’ adoption of “comprehensive primary care” capabilities might yield meaningful improvements in the quality and efficiency of primary care. However, many comprehensive primary care capabilities, such as care management and coordination, are not compensated via traditional fee-for-service payment. To calculate new payments for these capabilities, policymakers would need estimates of the costs that practices incur when adopting, maintaining, and using the capabilities. We performed a narrative review of the existing literature on the costs of adopting and implementing comprehensive primary care capabilities. These studies have found that practices incur significant costs when adopting and implementing comprehensive primary care capabilities. However, the studies had significant limitations that prevent extensive use of their estimates for payment policy. Particularly, the strongest studies focused on a small numbers of practices in specific geographic areas and the concepts and methods used to assess costs varied greatly across the studies. Furthermore, none of the studies in our review attempted to estimate differences in costs across practices with patients at varying levels of complexity and illness burden which is important for risk-adjusting payments to practices. Therefore, due to the heterogeneous designs and limited generalizability of published studies highlight the need for additional research, especially if payers wish to link their financial support for comprehensive primary care capabilities to the costs of these capabilities for primary care practices.

scholarly journals Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis

2021 ◽  
Vol 8 (1) ◽  
pp. 18-28
Author(s):  
Paula Tanabe ◽  
Audrey L. Blewer ◽  
Emily Bonnabeau ◽  
Hayden B. Bosworth ◽  
Denise H. Clayton ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
North Carolina ◽  
Sickle Cell Disease ◽  
Cost Benefit ◽  
Care Utilization ◽  
Evidence Based ◽  
Cell Disease ◽  
Ed Visits

Background: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.

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