What's the best way to reduce ED visits? A review of strategies

Certain interventions are more effective than others, study finds

Patient education, financial incentives, and managed care interventions are the most effective ways to prevent ED visits, according to a systematic review of medical research on the issue.

The review, published in the journal Academic Emergency Medicine, notes that many studies have explored the effect of interventions performed outside the ED to reduce ED utilization. While most of the interventions are successful, the degree to which they reduce ED admissions varies widely.

To gauge which non-ED interventions are most impactful, Jesse Pines—director of the Office of Clinical Practice Innovation at the George Washington University School of Medicine and Health Sciences—reviewed 39 studies that examined the impact of one of five interventions:


  • Patient education. Five studies examined the use of booklets or in-person educational sessions.
  • Increasing non-ED capacity. Ten studies looked a creating community clinics or expanding appointments or hours of care at existing physician practices.
  • Managed care. Twelve studies examined the use of capitated payments or primary care physician gatekeeping.
  • Pre-hospital diversion. Two studies analyzed the effect of emergency medical services' diversion of low-acuity patients.
  • Patient financial incentives. Ten studies used costs to incent the use of certain sites for care.

The review found that two-thirds of all the published studies showed a decrease in the number of ED visits following the intervention.

Patient education interventions had the greatest magnitude of reductions–two of the five studies on education found a decrease in ED use of 21% to 80%.

Meanwhile, interventions in patient financial incentives and managed care had the greatest number of studies showing reductions in the ED. Nine out of 10 studies on the power of incentives and 10 out of 12 studies on the effects of managed care demonstrated reductions in utilization.

  • An Advisory Board case study: Find out how a 771-bed hospital used Crimson to reduce ED utilization among frequent users. Click here.

Discussion

While many of the studies found large reductions in ED use, "only a handful of studies really look at patient outcomes," Pines wrote, adding, "Discouraging people from getting needed care has the potential for unintended consequences when sick people stay home."

Pines noted that reducing ED use is a major tenet of several Affordable Care Act initiatives. As such, new programs aimed at discouraging ED use must be reviewed "carefully to ensure they are safe and look at how they impact big picture costs," he concluded (Pines et al., AEM study, October 2013; Medscape Medical News, 10/24).


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