Validating the primary provider theory in emergency medicine

2008 ◽  
Vol 21 (2) ◽  
pp. 120-130 ◽  
Author(s):  
Joseph S. Guarisco ◽  
Stefoni A. Bavin

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.

2019 ◽  
Vol 27 (1) ◽  
pp. 37-49
Author(s):  
Daniel Chen ◽  
Alex M. Torstrick ◽  
Robert Crupi ◽  
Joseph E. Schwartz ◽  
Ira Frankel ◽  
...  

Purpose There is mixed evidence regarding the efficacy of low-intensity integrated care interventions in reducing the use of emergency services and costs of care. The purpose of this paper is to examine the effects of a low-intensity intervention formulated for older adults and delivered in an urban medical center serving low-income individuals. Design/methodology/approach The intervention included an initial evaluation of stress, psychiatric symptomatology and health habits; potential referrals for lifestyle management and psychiatric treatment; and training for physicians about the impact of lifestyle change in older adults. Participants included older adults (at or above 50 years of age) seen as outpatients in an urban medical center serving a low-income community (n=945). Participants were entered into the intervention at any point during this two-year period. Mixed models analyses examined all visits for all enrolled individuals over a two-year period, comparing visits before the individual received the initial intervention evaluation to those received after this evaluation. Outcomes included total health care costs incurred, average cost per visit, and emergency department (ED) usage within the facility. Findings The intervention was associated with reduced likelihood of emergency department use and reduced costs per visit following the intervention. These effects were seen across all participants. Research limitations/implications Limitations of the study include the lack of control group. Practical implications This program is easy to disseminate and could improve the quality of care and costs. Originality/value This study is among the few available to document a decrease in medical costs, as well as decreased ED utilization following a low-intensity integrated care intervention.


Author(s):  
Nancy O'Brien ◽  
Linda Saggau

Nancy O’Brien and Linda Saggau, co-founders of Experience Happiness, LLC., and co-developers of The Happiness Practice™ (THP), share key discoveries derived from the partnership between Hennepin County Medical Center (HCMC) and Experience Happiness (EH) which focused on using THP as an intervention to increase Emergency Department and Urgent Care practitioner well-being and happiness in order to reduce the signs and symptoms of burnout and improve patient experience and satisfaction. This article includes a case study demonstrating the efficacy of the 6-month THP intervention, as well as an overview of THP and seven valuable partnership lessons to encourage and guide successful partnerships in healthcare and other systems.


2013 ◽  
Vol 4 (2) ◽  
Author(s):  
Arinzechukwu Nkemdirim Okere ◽  
Charles Gessert ◽  
Colleen Renier ◽  
Michael Swanoski

Objective: The primary objective of this case study was to evaluate the impact of a medication reconciliation service (MRS) provided by student pharmacists in an emergency department (ED). Methods: Eligible patients were assigned to two groups, MRS or non-MRS. Patients in the MRS group were seen by student pharmacists while the non-MRS group followed usual care. As part of the services provided by the student pharmacists, medication reconciliation was provided under the supervision of a clinical pharmacist. At the conclusion of their ED visit, patients were asked to complete a survey addressing knowledge of medications, confidence in medication taking and patient satisfaction. To evaluate the impact of provision of MRS by student pharmacists on readmission rates in the ED, the electronic health records of the institution were queried for subsequent inpatient hospitalizations and ED visits. Results: Based on the study, patients in MRS group were more likely to be satisfied with the education provided to them in the ED (p=0.016) and had greater confidence in taking their medications (p=0.03). Sixty days post ED visit MRS group readmissions were significantly lower compared to non-MRS group (P= 0.047). Conclusions: Students' participation in the provision of medication reconciliation led to reduction of readmission in the tertiary care ED, improved patient satisfaction and confidence in medication use.   Type: Case Study


2022 ◽  
Author(s):  
Nissim Ohana ◽  
Itzhak Engel ◽  
Yuval Baruch ◽  
Daniel Benharroch ◽  
Dimitri Sheinis

Abstract Purpose: To assess the rate of visits to the emergency department of our medical center concerning low back or neck pain, as a factor of COVID-19 confinements.Methods: The study period was a 30-weeks interval during the COVID-19 pandemic contrasted by a similar stretch in the year preceding the epidemic. The visits to the Emergency Department, prompted by low back or neck pain, were recorded prior and during lockdowns of the pandemic. The significance of the confinements for the development of the pain syndromes was evaluated.Results: A total of 1530 patients with newly diagnosed back or neck pain were enrolled. Most patients visited our emergency department for low back pain, commonly those older than 60 years. No significant gender variance was disclosed, though most visits of females were for low back pain. Low back pain presentations were curbed following confinement, but the rate of stays for neck pain had swelled by more than 10%. Despite back pain predominance, visits for neck pain persisted. Before COVID-19, the average weekly number of Emergency Department visits was 38.5. This was followed by sharp drops during COVID-19 lockdown (mean different=-22.2, 95%CI=-28.7, -15.7, p<0.001) (not significant).Conclusions: COVID-19 lockdowns have a significant impact on the Emergency Department’s presentations due to back and neck pain. A higher rate of presentation for back pain compared to neck pain is probably related to COVID-19, without being affected directly by the SARS-CoV-2: confinement-induced immobility might instigate musculoskeletal sequels, which may be attributed to stress or other psycho-social afflictions.


2021 ◽  
Vol 8 ◽  
pp. 237437352110114
Author(s):  
Andrew Nyce ◽  
Snehal Gandhi ◽  
Brian Freeze ◽  
Joshua Bosire ◽  
Terry Ricca ◽  
...  

Prolonged waiting times are associated with worse patient experience in patients discharged from the emergency department (ED). However, it is unclear which component of the waiting times is most impactful to the patient experience and the impact on hospitalized patients. We performed a retrospective analysis of ED patients between July 2018 and March 30, 2020. In all, 3278 patients were included: 1477 patients were discharged from the ED, and 1680 were admitted. Discharged patients had a longer door-to-first provider and door-to-doctor time, but a shorter doctor-to-disposition, disposition-to-departure, and total ED time when compared to admitted patients. Some, but not all, components of waiting times were significantly higher in patients with suboptimal experience (<100th percentile). Prolonged door-to-doctor time was significantly associated with worse patient experience in discharged patients and in patients with hospital length of stay ≤4 days. Prolonged ED waiting times were significantly associated with worse patient experience in patients who were discharged from the ED and in inpatients with short length of stay. Door-to-doctor time seems to have the highest impact on the patient’s experience of these 2 groups.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Axel Kaehne ◽  
Paula Keating

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.


2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson

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.


Author(s):  
Maria Bres Bullrich ◽  
Sebastian Fridman ◽  
Jennifer L. Mandzia ◽  
Lauren M. Mai ◽  
Alexander Khaw ◽  
...  

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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