High-cost sharing policies and non-urgent emergency department visits

2018 ◽  
Vol 31 (7) ◽  
pp. 735-745
Author(s):  
Haichang Xin
Keyword(s):  
Emergency Department ◽  
Ambulatory Care ◽  
Cost Sharing ◽  
Low Cost ◽  
Chronically Ill ◽  
Medical Expenditure ◽  
Care Utilization ◽  
Health Plans ◽  
Content Type ◽  
Care Policies

Purpose The purpose of this paper is to examine whether high-cost-sharing ambulatory care policies affect non-urgent emergency department (ED) care utilization differently among individuals with and without chronic conditions. Design/methodology/approach This retrospective cohort study used 2010–2011 US Medical Expenditure Panel Survey data. Difference-in-difference methods, multivariate logit model and survey procedures were employed. Time lag effect was used to address endogeneity concerns. Findings The sample included 4,347 individuals. Difference in non-urgent ED visits log odds between high- and low-cost-sharing policies was not significantly different between chronically ill and non-chronically ill individuals (β=−0.48, p=0.42). Sensitivity analysis with 15 and 25 percent cost-sharing levels also generated consistent insignificant results (p=0.33 and p=0.31, respectively). Ambulatory care incidence rates were not significantly different between high- and low-cost-sharing groups among chronically ill people (incidence rate ratio=0.849, p=0.069). Practical implications High-cost-sharing ambulatory care policies were not associated with increased non-urgent ED care utilization among chronically ill and healthy people. The chronically ill patients may have retained sizable ambulatory care that was necessary to maintain their health. Health plans or employers may consider low-level cost-sharing policies for ambulatory care among chronically ill enrollees or employees. Originality/value Findings contribute to insurance benefit design; i.e., whether high-cost-sharing ambulatory care policies should be implemented among chronically ill enrollees to maintain their health and save costs for health plans.

End-of-life Health-Care Utilization Patterns Among Chronically Ill Older Adults

2019 ◽  
Vol 36 (6) ◽  
pp. 507-512 ◽  
Author(s):  
Meredith MacKenzie Greenle ◽  
Karen B. Hirschman ◽  
Ken Coburn ◽  
Sherry Marcantonio ◽  
Alexandra L. Hanlon ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
End Of Life ◽  
Emergency Department Visit ◽  
Chronically Ill ◽  
Care Utilization ◽  
Utilization Patterns ◽  
Over Time

Patients with chronic illness are associated with high health-care utilization and this is exacerbated in the end of life, when health-care utilization and costs are highest. Complex Care Management (CCM) is a model of care developed to reduce health-care utilization, while improving patient outcomes. We aimed to examine the relationship between health-care utilization patterns and patient characteristics over time in a sample of older adults enrolled in CCM over the last 2 years of life. Generalized estimating equation models were used. The sample (n = 126) was 52% female with an average age of 85 years. Health-care utilization rose sharply in the last 3 months of life with at least one hospitalization for 67% of participants and an emergency department visit for 23% of participants. In the last 6 months of life, there was an average of 2.17 care transitions per participant. The odds of hospitalization increased by 27% with each time interval ( P < .001). Participants demonstrated 11% greater odds of having a hospitalization for each additional comorbidity ( P = .05). A primary diagnosis of heart failure or coronary artery disease was associated with 21% greater odds of hospitalization over time compared to other primary diagnoses ( P = .017). Females had 70% greater odds of an emergency department visit compared to males ( P = .046). For each additional year of life, the odds of an emergency department visit increased by about 7% ( P < .001). Findings suggest the need for further interventions targeting chronically ill older adults nearing end of life within CCM models.

scholarly journals P.144 Health care utilization by patients seen at a tertiary headache clinic

2018 ◽  
Vol 45 (s2) ◽  
pp. S22-S22
Author(s):  
CE Holtby ◽  
F Amoozegar ◽  
LJ Cooke
Keyword(s):  
Emergency Department ◽  
Ambulatory Care ◽  
Multidisciplinary Treatment ◽  
Median Number ◽  
Management Program ◽  
Emergency Department Visits ◽  
Treatment Programs ◽  
Care Utilization ◽  
Before And After ◽  
Headache Clinic

Background: Multidisciplinary treatment programs benefit headache patients. No evidence exists as to whether they change resource use. A historical prospective cohort study was performed to compare the frequency of ambulatory care and emergency department visits for the purposes of headache by patients seen at the Calgary Headache Assessment and Management Program (CHAMP) in the three years before, and after, their first appointment. Methods: Administrative data from Alberta Health was used. All patients seen by a physician at CHAMP from 2003-2013 were included. Sample characteristics were described and the Wilcoxan signed rank sum test was used to compare the number of ambulatory care and emergency department visits in the three years before and after each patient’s first physician appointment at CHAMP. Follow-up visits at CHAMP were excluded from analyses. Results: The median number of ambulatory care visits over three years changed from 4 to 2 (p<0.001). The median number of emergency department visits was zero before and after assessment at CHAMP. The mean number of emergency department visits changed from 1.5 to 1.2 (p<0.0001). Conclusions: Enrollment in a multidisciplinary headache program reduces the number of ambulatory care visits and emergency department visits for purposes of headache.

scholarly journals Emergency department and inpatient health care utilization among patients who require interpreter services

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Jane W. Njeru ◽  
Jennifer L. St. Sauver ◽  
Debra J. Jacobson ◽  
Jon O. Ebbert ◽  
Paul Y. Takahashi ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Interpreter Services

scholarly journals Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
Author(s):  
Jean Claude Byiringiro ◽  
Rex Wong ◽  
Caroline Davis ◽  
Jeffery Williams ◽  
Joseph Becker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Success Factors ◽  
Low Cost ◽  
Post Intervention ◽  
Triage System ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

Value communication: low-cost marketing initiatives for “Guru Ki Bani 58282”

2013 ◽  
Vol 3 (3) ◽  
pp. 1-9
Author(s):  
Neeraj Pandey ◽  
Gaganpreet Singh
Keyword(s):  
Interactive Voice Response ◽  
Low Cost ◽  
Value Added ◽  
Subject Area ◽  
Marketing Management ◽  
Digital Marketing ◽  
Content Type ◽  
Mba Students ◽  
Marketing Team ◽  
Value Communication

Subject area Pricing, digital marketing, marketing management and strategic marketing. Study level/applicability The case can be used for pricing or digital marketing courses as well as marketing management courses to MBA students and/or for management development programmes. Case overview Goldfinch Mobile Solutions, a Hong-Kong based value added services (VAS) and gaming platform provider, had an exclusive tie up with Bharti Airtel in India for providing value added voice applications on an interactive voice response system (IVRS) platform. The Goldfinch flagship service is “Guru Ki Bani” which may be subscribed to by dialing the short code 58282. This “58282” service has a repository of all Sikh religion daily prayers, religious songs, teachings, stories from Guru's life and similar information that is derived from the Sikh Holy book Guru Granth Sahib Ji. As per mutual agreement between Goldfinch Mobile Solutions and Bharti Airtel, the telecom operator had the responsibility to promote Goldfinch's Guru Ki Bani service amongst its subscriber base through its below the line (BTL) promotional channels such as short messaging service (SMS), outbound calls, cell information, notification SMS after call and above the line (ATL) activities such as posters, leaflets, print, promoters, regional TV, outdoors, etc. The revenue sharing arrangement between Airtel and Golfinch was in the ratio of 75 percent and 25 percent. However, with recent changes in the policies of Telephone Regulatory Authority of India (TRAI), promotional marketing used by telecom operators has been constrained. Declining customer share, decreasing profits (after Bharti Airtel halted promotions) and increasing organization cost per customer have made MD and CEO Mr Newton Bubber think of various options including low-cost marketing initiatives besides digital marketing to promote Guru Ki Bani services. Value communication to its huge potential customer base, i.e. 184.19 million Bharti Airtel subscribers was another challenge facing Mr Newton and his marketing team at Goldfinch. Expected learning outcomes The case enables students to learn the concepts and application of value creation, effective value communication, price waterfall analysis, importance of costing parameters in pricing decisions, low-cost marketing strategies and digital marketing. Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email [email protected] to request teaching notes.

scholarly journals P070: Mixed effectiveness of emergency department diversion strategies: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S102
Author(s):  
S.W. Kirkland ◽  
A. Soleimani ◽  
B.H. Rowe ◽  
A.S. Newton
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Services ◽  
Grey Literature ◽  
Study Data ◽  
Care Utilization ◽  
Alternative Source ◽  
Increased Risk ◽  
The Impact

Introduction: Diverting patients away from the emergency department (ED) has been proposed as a solution for reducing ED overcrowding. The objective of this systematic review is to examine the effectiveness of diversion strategies designed to either direct patients seeking care at an ED to an alternative source of care. Methods: Seven electronic databases and grey literature were searched. Randomized/controlled clinical trials and cohort studies assessing the effectiveness of pre-hospital and ED-based diversion interventions with a comparator were eligible for inclusion. Two reviewers independently screened the studies for relevance, inclusion, and risk of bias. Intervention effects are reported as proportions (%) or relative risks (RR) with 95% confidence intervals (CI). Methodological and clinical heterogeneity prohibited pooling of study data. Results: From 7,306 citations, ten studies were included. Seven studies evaluated a pre-hospital diversion strategy and three studies evaluated an ED-based diversion strategy. The impact of diversion on subsequent health services was mixed. One study of paramedic practitioners reported increased ED attendance within 7 days (11.9% vs. 9.5%; p=0.049) but no differences in return visits for similar conditions (75.2% vs. 72.1%; p=0.64). The use of paramedic practitioners was associated with an increased risk of subsequent contact with health care services (RR=1.21, 95% CI 1.06, 1.38), while the use of deferred care was associated with no increase in risk of subsequently seeking physician care (RR=1.09, 95% CI 0.23, 5.26). While two studies reported that diverted patients were at significantly reduced risk for hospitalization, two other studies reported no significant differences between diverted or standard care patients. Conclusion: The evidence regarding the impact of pre-hospital and ED-based diversion on ED utilization and subsequent health care utilization is mixed. Additional high-quality comparative effectiveness studies of diversion strategies are required prior to widespread implementation.

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