The impact of nurse practitioner and physician assistant workforce supply on Medicaid-related emergency department visits and hospitalizations

Abstract Background Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders. Method The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders. Results ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others. Conclusion The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service.

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Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits

The European Journal of Health Economics ◽

10.1007/s10198-021-01300-5 ◽

2021 ◽

Author(s):

Ruben Willems ◽

◽

Fouke Ombelet ◽

Eva Goossens ◽

Katya De Groote ◽

...

Keyword(s):

Emergency Department ◽

Congenital Heart Disease ◽

Heart Disease ◽

Cost Analysis ◽

Congenital Heart ◽

Emergency Department Visits ◽

Levels Of Care ◽

The Impact ◽

Different Levels

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Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

Injury Epidemiology ◽

10.1186/s40621-021-00308-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Lauren Alexis De Crescenzo ◽

Barbara Alison Gabella ◽

Jewell Johnson

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Interrupted Time Series ◽

Emergency Department Visits ◽

Control And Prevention ◽

Icd 10 ◽

Ed Visits ◽

The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.101 ◽

2020 ◽

Vol 47 (5) ◽

pp. 693-696 ◽

Cited By ~ 12

Author(s):

Maria Bres Bullrich ◽

Sebastian Fridman ◽

Jennifer L. Mandzia ◽

Lauren M. Mai ◽

Alexander Khaw ◽

...

Keyword(s):

Emergency Department ◽

Stroke Prevention ◽

Stroke Unit ◽

Emergency Department Visits ◽

Related Factors ◽

Hospital Policies ◽

The Government ◽

Stroke Center ◽

The Impact ◽

Prevention Clinic

Abstract:We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

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The Impact of the Affordable Care Act Insurance Expansions on Opioid‐Related Emergency Department Visits

Health Services Research ◽

10.1111/1475-6773.13787 ◽

2021 ◽

Vol 56 (S2) ◽

pp. 64-64

Author(s):

Sandra Decker ◽

Michael Dworsky ◽

Teresa Gibson ◽

Rachel Henke ◽

Kimberly McDermott

Keyword(s):

Emergency Department ◽

Affordable Care Act ◽

Emergency Department Visits ◽

The Affordable Care Act ◽

The Impact

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Validating the primary provider theory in emergency medicine

Leadership in Health Services ◽

10.1108/17511870810870565 ◽

2008 ◽

Vol 21 (2) ◽

pp. 120-130 ◽

Cited By ~ 2

Author(s):

Joseph S. Guarisco ◽

Stefoni A. Bavin

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Pay For Performance ◽

Medical Center ◽

Waiting Times ◽

Emergency Department Visits ◽

Business Success ◽

Content Type ◽

The Impact

PurposeThe purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables, patient satisfaction is distinctly and primarily linked to physician behaviors and secondarily to waiting times.Design/methodology/approachThe case study began by creating incentives motivating physicians to reflect and improve behaviors (patient interactions) and practice patterns (workflow efficiency). The Press Ganey Emergency Department Survey was then utilized to track the impact of the incentive programs and to ascertain any relationship between patient satisfaction with the provider and global patient satisfaction with emergency department visits by measuring patient satisfaction over an eight quarter period.FindingsThe findings were two‐fold: firstly, the concept of “pay for performance” as a tool for physician motivation was valid; and secondly, the impact on global patient satisfaction by increases in patient satisfaction with the primary provider was significant and highly correlated, as proposed by Aragon.Practical implicationsThese findings can encourage hospitals and physician groups to place a high value on the performance of primary providers of patient care, provide incentives for appropriate provider behaviors through “pay for performance” programs and promote physician understanding of the links between global patient satisfaction with physician behaviors and business growth, malpractice reduction, and other key measures of business success.Originality/valueThere are no other case studies prior to this project validating the Primary Provider Theory in an urban medical center; this project adds to the validity and credibility of the theory in this setting.

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Emergency department visits for children with acute asthma: discharge instructions, parental plans, and follow-through of care—a prospective study

CJEM ◽

10.1017/s1481803500003481 ◽

2014 ◽

Vol 16 (06) ◽

pp. 467-476 ◽

Cited By ~ 2

Author(s):

Pat G. Camp ◽

Seamus P. Norton ◽

Ran D. Goldman ◽

Salomeh Shajari ◽

M. Anne Smith ◽

...

Keyword(s):

Emergency Department ◽

Acute Care ◽

Family Doctor ◽

Emergency Department Visits ◽

Upper Respiratory Tract ◽

Asthma Exacerbations ◽

Initial Care ◽

Children With Asthma ◽

Tract Infections ◽

The Impact

Abstract Objective: Communication between emergency department (ED) staff and parents of children with asthma may play a role in asthma exacerbation management. We investigated the extent to which parents of children with asthma implement recommendations provided by the ED staff. Method: We asked questions on asthma triggers, ED care (including education and discharge recommendations), and asthma management strategies used at home shortly after the ED visit and again at 6 months. Results: A total of 148 children with asthma were recruited. Thirty-two percent of children were not on inhaled corticosteroids prior to their ED visit. Eighty percent of parents identified upper respiratory tract infections (URTIs) as the primary trigger for their child’s asthma. No parent received or implemented any specific asthma strategies to reduce the impact of URTIs; 82% of parents did not receive any printed asthma education materials. Most (66%) parents received verbal instructions on how to manage their child’s future asthma exacerbations. Of those, one-third of families were told to return to the ED. Parents were rarely advised to bring their child to their family doctor in the event of a future exacerbation. At 6 months, parents continued to use the ED services for asthma exacerbations in their children, despite reporting feeling confident in managing their child’s asthma. Conclusion: Improvements are urgently needed in developing strategies to manage pediatric asthma exacerbations related to URTIs, communication with parents at discharge in acute care, and using alternate acute care services for parents who continue to rely on EDs for the initial care of mild asthma exacerbations.

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Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

Injury Epidemiology ◽

10.1186/s40621-021-00307-z ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Matthew J Molloy ◽

Wendy Shields ◽

Molly W Stevens ◽

Andrea C Gielen

Keyword(s):

Emergency Department ◽

Pediatric Population ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

Short Term ◽

Minor Injury ◽

Minor Injuries ◽

A Minor ◽

The Impact ◽

At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

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