Reducing Emergency Room Visits Research Articles

A Community-based Intervention to Improve Health Outcomes for Vietnamese Americans

Abstract: Vietnamese Americans experience significant health disparities compared with other groups, but their health care utilization is suboptimal. Boat People SOS (BPSOS), a nationwide Vietnamese-serving community-based organization, implemented a community health worker and community-clinical linkage electronic referral system to improve health care utilization. Three sites (in Alabama, California, and Virginia) received the intervention; Mississippi was the comparison site. The intervention included bridging between communities and health systems, culturally appropriate health education, informal counseling and social support, advocating for individual and community needs, direct services, and building individual and community capacity through partnerships with service providers. Compared with the comparison site, clients at the intervention sites reported better overall perceived health after the intervention. Past-year medical checkups declined in both groups during the COVID-19 pandemic but declined less in the treatment group. The intervention did not reduce emergency room visits. Findings suggest that this intervention can improve health care utilization and health status among Vietnamese Americans.

Early Intervention by Family Physicians to Delay Type 1 Diabetes.

Type 1 diabetes (T1D) is an autoimmune disease mediated by T cells that target and destroy insulin-producing beta cells. Individuals with genetic risk of T1D will progress at variable rates through 3 stages of immune activation and development of islet autoimmunity. Measuring pancreatic islet cell autoantibodies predicts risk for progression that can take weeks to years before the onset of T1D. Screening options available to family physicians can identify persons at risk or in the early stages of T1D, such as first- and second-degree relatives or those with a family history of autoimmune disorders, to ultimately offer proven interventions that may delay or prevent the condition. Screening can reduce emergency room visits, hospitalizations, and intensive care unit admissions for diabetic ketoacidosis, which can be fatal, and can educate and prepare individuals and families for a smoother transition to insulin therapy when necessary. Recent advances in technology and understanding of the immune pathogenesis of T1D has resulted in emerging disease-modifying therapies that are changing how family physicians approach delaying and potentially preventing or reversing the disease.

997-P: Social Risk Domains and Emergency Room Visits among Adults with Diabetes and Low Income

Background: In the U.S., more than 34 million adults ≥18 years of age are estimated to have diabetes. Adults with low-income levels are disproportionately impacted. Adverse social conditions associated with poor health, or social risk factors, contribute to poorer access to care, lower quality of care, and worsened clinical outcomes among these adults. The objective of this study was to assess the relationship between social risk domains and hospital utilization among adults with diabetes and low income. Methods: Data of 5,077 adults with diabetes and income <$50,000 or receiving income or assistance from welfare programs or disability insurance (weighted sample = 41,735,609) from the National Health Interview Survey (NHIS) were analyzed. The outcomes were “Have visited the Emergency Room (ER) about own health in past 12 months (yes/no)”, and “Number of times visited ER in past 12 months”. The independent variables were five social risk domains (economic instability, neighborhood and built environment, education access, food insecurity, social and community context). Covariates included age, sex, race/ethnicity, insurance, marital status, employment, comorbidity, region. Logistic regression models were used to assess the independent association between each outcome and each social risk domain. Results: In the fully adjusted model, adults with social and community context risks had a 76% higher risk of visiting the emergency room for their own health in the past 12 months. Also, for each unit increase in the number of times an adult visited the emergency room, there was a significant association with economic instability (βeta (β) coefficient=0.39, (95% CI 0.14, 0.64)), food insecurity (β=0.31, (95% CI 0.13, 0.50)), and social/community risk (β=0.54, (95% CI 0.38, 0.70)). Conclusions: These findings suggest the need for mitigating the influence of social and community factors, economic instability, and food insecurity among adults with diabetes and low income to reduce ER visits. Disclosure J.S.Williams: None. Y.Xu: None. S.Bhandari: None. M.N.Ozieh: None. O.J.Akinboboye: None. L.E.Egede: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861, R21DK123720)

Patient characteristics and outcomes among bariatric surgery patients with high narcotic overdose scores.

Obesity-related chronic pain can increase the risk of narcotic abuse in bariatric surgery patients. However, assessment of overdose risk has not been evaluated to date. A NARxCHECK® overdose score ("Narx score") was obtained preoperatively on all patients undergoing bariatric surgery (n = 306) between 2018 and 2020 at a single-center academic bariatric surgery program. The 3-digit score ranges from 000 to 999 and is based on patient risk factors found within the Prescription Drug Monitoring Program. A Narx score ≥ 200 indicates tenfold increased risk of narcotic overdose. Patient characteristics, comorbidities, and emergency room (ER) visits were compared between patients in the upper (≥ 200) and lower (000) terciles of Narx scores. Morphine milligram equivalent (MME) prescribed at discharge and refills was also evaluated. Patients in the upper tercile represented 32% (n = 99) of the study population, and compared to the lower tercile (n = 101, 33%), were more likely to have depression (63.6% vs 38.6%, p = 0.0004), anxiety (47.5% vs 30.7%, p = 0.0150), and bipolar disorder (6.1% vs 0.0%, p = 0.0120). Median MME prescribed at discharge was the same between both groups (75); however, high-risk patients were more likely to be prescribed more than 10 tablets of a secondary opioid (83.3% vs 0.0%, p = 0.0111), which was prescribed by another provider in 67% of cases. ER visits among patients who did not have a complication or require a readmission was also higher among high-risk patients (7.8% vs 0.0%, p = 0.0043). There were no deaths or incidents of mental health-related ER visits in either group. Patients with a Narx score ≥ 200 were more likely to have mental health disorders and have potentially avoidable ER visits in the setting of standardized opioid prescribing practices. Narx scores can help reduce ER visits by identifying at-risk patients who may benefit from additional clinic or telehealth follow-up.

Oncology Urgent Care Clinics: Understanding Utilization and Best Practices.

An oncology urgent care clinic can improve patient satisfaction, reduce emergency room visits, and lower health-care costs for patients and facilities. At a session taking place at JADPRO Live Virtual 2021, presenters on the frontlines of the development of an oncology urgent care clinic provided the audience with an inside look at metrics, logistics, and workflow used when establishing a successful advanced practitioner-led oncology urgent care clinic.

Real-World Implementation and Accuracy of an Artificial Intelligence-Based eHealth System Designed to Predict and Reduce Emergency Room Visits by Frail Older Adults: A Pragmatic Trial

Real-World Implementation and Accuracy of an Artificial Intelligence-Based eHealth System Designed to Predict and Reduce Emergency Room Visits by Frail Older Adults: A Pragmatic Trial

Group Prenatal Care and Emergency Room Utilization.

Pregnancy-related complaints are a significant driver of emergency room (ER) utilization among women. Because of additional time for patient education and provider relationships, group prenatal care may reduce ER visits among pregnant women by helping them identify appropriate care settings, improving understanding of common pregnancy discomforts, and reducing risky health behaviors. We conducted a retrospective cohort study, utilizing Medicaid claims and birth certificate data from a statewide expansion of group care, to compare ER utilization between pregnant women participating in group prenatal care and individual prenatal care. Using propensity score matching methods, we found that group care was associated with a significant reduction in the likelihood of having any ER utilization (-5.9% among women receiving any group care and -6.0% among women attending at least five group care sessions). These findings suggest that group care may reduce ER utilization among pregnant women and encourage appropriate health care utilization during pregnancy.

Telemonitoring for Home-assisted Ventilation: A Narrative Review.

The recent advent of remote ventilator telemonitoring has the potential to revolutionize home-assisted ventilation care in the United States and elsewhere. Home ventilation machines (i.e., respiratory assist devices and portable ventilators) can now wirelessly transmit usage and performance data to cloud-based web servers for remote access by participating clinicians. In this Focused Review, we provide an update on available technology, suggest practical applications for clinical care and research, and review supporting literature. Remote monitoring permits early data review, refinement of device settings to optimize ventilatory function, and troubleshooting if a new problem arises after initial setup. Data from home spirometry and noninvasively measured blood gas tensions can complement ventilator data to reflect physiological response. Acknowledging a paucity of published outcome studies, remote telemonitoring may be a cost-effective strategy to reduce emergency room visits, urgent clinic appointments, and hospitalizations. Ongoing clinical trials in Europe aim to expand on the benefit of this rapidly evolving technology. However, several barriers may hinder widespread implementation, especially in the United States. Clinicians must familiarize themselves with each ventilator manufacturer’s proprietary software to safely leverage this technology for improving care. Legal and ethical considerations threaten clinician interest. Medical insurance payers must adapt a reimbursement scheme to incentivize clinicians and durable medical equipment companies to perform this time-consuming service. Cohort-level ventilator data will facilitate multicenter clinical trials focused on improving the respiratory care of this vulnerable population.

Efficacy of a Pediatric Headache Infusion Center in Reducing Emergency Room Visits and Cost of Care (1932)

Efficacy of a Pediatric Headache Infusion Center in Reducing Emergency Room Visits and Cost of Care (1932)

Treatment navigation to reduce emergency room (ER) visits in cancer patients.

199 Background: The practice of conventional oncology has undoubtedly changed in the last 15 years, becoming more efficient, but also more complex and expensive. This complex care needs significant coordination. In the last 2 years in half of the continuing development of our care coordination working in the "Navigation Treatment" domain, the impact on reducing ER visits was, in media, 75%. Methods: In 2015 IOV developed a patient-centered Navigation System based on Kanban (board and visual signals-KNS) for managing the treatment plan of our patients that was successful. In 2016 with support of an educational grant from QTP-ASCO, we extended this system to manage pain to others cancers and treatment-related symptoms, education, resource referral or Coordination of multi-disciplinary care. This study addresses only decreased ER visits between Dec 15 and May 20 by all patients monitored by Nurses navigators. We measured the proportional reduction of ER visits related to pain to the total ER visits in three successive periods: development of the NKS (dec15-jul16), pilot phase (aug16-oct17), and as an adopted best practice (oct17-until today). The KNS comprises a set of standardized procedures and successive checks for patients in treatment based on three procedures: (a) standardized treatments prescriptions to pain and symptoms controls; (b) standardized follow up in 24 and 48 hours, 1, 2 and 4 weeks; and (c) manage side effects of opioids or other emerging problem (constipation, confusion, mucositis, diarrhea, fever, etc.). Any patient initiating opioid use is included in the KNS until opioid is discontinued. Once pain is adequately controlled, the frequency of checks become wider up to once a month if no toxicity is identified. Any new condition (will restart the 24-48 hours loop. The KNS is managed by oncology nurses using phone or video calls, messaging, and appointments; Mon-Sun from 6 AM to 8 PM. Results: The KNS managed a median of 204 (table*) patients per month during the last 32 months (Oct 17 to May 20). Patients with pain, symptoms, or side effects that were effectively managed by the team avoided an unwanted visit to the ER, in media by 75%. Pain represents 20% of ER visits generally; in pilot phase 15% of ER visits, and actually 4% of ER visits, an 80% reduction in pain-related ER visits. ER visits represent patients with uncontrolled pain and not effectively managed by the KNS. Conclusions: The development of a system to deliver more effective care patients resulted in a 75% reduction of ER visits and adequate pain control in our practice.

Interpreting COVID-19 and Virtual Care Trends: Cohort Study.

BackgroundThe coronavirus disease (COVID-19) pandemic is rapidly spreading across the world. As of March 26, 2020, there are more than 500,000 cases and more than 25,000 deaths related to COVID-19, and the numbers are increasing by the hour.ObjectiveThe aim of this study was to explore the trends in confirmed COVID-19 cases in North Carolina, and to understand patterns in virtual visits related to symptoms of COVID-19.MethodsWe conducted a cohort study of confirmed COVID-19 cases and patients using an on-demand, statewide virtual urgent care center. We collected data from February 1, 2020, to March 15, 2020. Institutional Review Board exemption was obtained prior to the study.ResultsAs of March, 18 2020, there were 92 confirmed COVID-19 cases and 733 total virtual visits. Of the total visits, 257 (35.1%) were related to COVID-19-like symptoms. Of the COVID-19-like visits, the number of females was 178 (69.2%). People in the age groups of 30-39 years (n=67, 26.1%) and 40-49 years (n=64, 24.9%) were half of the total patients. Additionally, approximately 96.9% (n=249) of the COVID-like encounters came from within the state of North Carolina. Our study shows that virtual care can provide efficient triaging in the counties with the highest number of COVID-19 cases. We also confirmed that the largest spread of the disease occurs in areas with a high population density as well as in areas with major airports.ConclusionsThe use of virtual care presents promising potential in the fight against COVID-19. Virtual care is capable of reducing emergency room visits, conserving health care resources, and avoiding the spread of COVID-19 by treating patients remotely. We call for further adoption of virtual care by health systems across the United States and the world during the COVID-19 pandemic.

Continuity of Care in Chronic Diseases: A Concept Analysis by Literature Review.

This study aimed to utilize concept analysis to obtain a better understanding of the concept of "continuity of care" in chronic diseases. The concept of continuity of care was analyzed using the Walker and Avant method. Covering literature in English from 1930 to 2018, the data sources included CINAHL Complete, Academic Search Complete, MEDLINE, PsyARTICLES, Health Source: Nursing/Academic Edition, Google Scholar, Science Direct, and the Cochrane Library. A comprehensive definition of concept of continuity of care was developed based on a systematic search and synthesis. The key defining attributes were identified as (a) care over time, (b) the relationship between an individual patient and a care team, (c) information transfer, (d) coordination, and (e) meeting changing needs. The antecedents of continuity of care were having a chronic disease, inexperienced with disease management, a poorly coordinated healthcare system, and medical care limitations. The consequences of continuity of care were decreasing hospital admissions, reducing costs, reducing emergency room visits, improving the quality of life, improving patient satisfaction, and delivering good healthcare. The thorough concept analysis provides insight into the nature of "continuity of care" in chronic diseases and also helps ground the concept in healthcare.

THE IMPACT OF KNOWLEDGE TRANSLATION AND INTEGRATED CARDIOVASCULAR CARE ON EMERGENCY ROOM VISITS OF PATIENTS WITH ATRIAL FIBRILLATION: INSIGHTS FROM THE INTEGRATED-FACILITER PROGRAM

Atrial fibrillation (AF) is a common disease with high burden of emergency room (ER) visits. The impact of integrated nursing-led care and knowledge translation (KT) remains unclear in the management of AF. We aim to evaluate whether a one-year program of nursing-led KT and integrated cardiovascular (CV) care would reduce ER visits for CV-related conditions in patients with AF.

Mobile short message service (SMS) alerts for reducing the toxicity and improving protocol compliance during cancer chemotherapy: A randomized controlled trial.

e18331 Background: Text message-based interventions has been used to facilitate patient care and enhance compliance in clinical oncology. This trial assessed the benefit of text message in reducing emergency room visits and other outcomes related to toxicity and expenses during cytotoxic chemotherapy. Methods: The study was funded by an International Innovation Grant from ASCO. This single center randomised controlled trial was done after approval from our Institutional Review Board. Briefly patients due to take 3-weekly chemotherapy for stomach/gastroesophageal cancer, colorectal cancer, breast cancer and lymphoma were enrolled. Randomization (1:1) was stratified by site and type of chemotherapy. Patients in standard care arm (STD) were given verbal and/or written instructions at the start of each chemotherapy cycle. The interventional (SMS) arm received periodic text messages in addition to the standard care on early warning signs of toxicity at regular intervals during each chemotherapy cycle. Participants were evaluated at the baseline and then followed up for 3 cycles (adjuvant setting) or 4 cycles (palliative setting). Primary endpoint was emergency room (ER) visits. Secondary endpoints included Suspected Unexpected Serious Adverse Reactions (SUSARs), delayed chemotherapy cycles, dose reductions, total cost of care and out of pocket expenditure. The study was designed with a sample size of 400 subjects with an interim analysis planned when 190 patients were randomized. Results: From May 2015 to June 2016, 191 patients were randomized and 189 completed the study [97 in SMS arm and 92 in STD arm]. The median age was 51 years (Range: 23-69) and male:female was 1:2. The relative risk (RR) for ER visit compared to STD arm was 1.09 (95% CI: 0.86-1.38; p = 0.46). The RR for SUSARs was 1.04 (95% CI: 0.99-1.09; p = 0.2); the RR for dose delay was 1.06 (95% CI: 0.9-1.26; p = 0.44) and the RR for dose reduction and 1.16 (95% CI: 1-1.33; p = 0.03). This study was closed prematurely for futility. Conclusions: Text (SMS) message-based patient education during cancer chemotherapy does not to reduce ER visits, SUSARs or cost of care. Clinical trial information: CTRI/2015/02/005491.

The Impact of the Patient-Centered Medical Home on Asthma-Related Visits to the Emergency Room: A Fixed Effects Regression Approach.

Objective To estimate the effect of a patient-centered medical home (PCMH) intervention on asthma-related emergency room (ER) visits of pediatric patients. Methods Patients receiving care at pediatric primary care practices participating in the Florida Pediatric Medical Home Demonstration Project as well as pediatric patients treated at non-participating clinics were identified from 4 years of claims and enrollment data. We estimate several fixed effects logistic regression models using one pre-treatment year and three post-treatment years to investigate whether asthma-related ER visits decreased because of the PCMH intervention. Results The estimation suggests that the intervention did have a negative effect on asthma-related ER visits in the earlier part of the intervention (OR 0.34; 95% CI 0.16-0.73). However, this effect was not detected in the later years. Because fixed effects models require repeated observations on the same individual, we believe our estimations of the PCMH model's impact is more accurate than previous studies. Conclusion for Practice Reducing asthma ER visits is a task that might be immediately actionable for PCMH practices, or those undergoing transformation. Our results adds to the others suggesting positive impacts of the PCMH.

The Effectiveness of Transitions-of-Care Interventions in Reducing Hospital Readmissions and Mortality: A Systematic Review.

The Affordable Care Act of 2010 set forth payment models that provided $10 billion to incent the health care system in developing innovative programs that target reform, including transitional care to reduce preventable readmissions. While transitional care programs exist, US hospitals remain challenged, with 1 in 5 readmissions within 30 days. This systematic review examined the effectiveness of select evidence-based transitions-of-care interventions on reducing 30-day readmission rates, reducing emergency room visits, and reducing mortality rates. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines formed the framework for this systematic review. Key study characteristics informed the eligibility criteria and search strategy. Two reviewers independently appraised selected studies using the Critical Appraisal Skills Programme tools. Included studies were summarized and synthesized in order to draw conclusions across studies. Interventions are aimed at reducing the readmission rate of the adult general medical population. The population of focus in this review includes patients at risk of avoidable readmissions, which includes patients requiring higher levels of care secondary to complications that can contribute to higher mortality after discharge from an acute care setting. The findings of this review support the use of transitions-of-care interventions such as tailored discharge planning and postdischarge phone calls.

Telemedicine Helps Cardiologists Extend Their Reach.

During a recent set of telemedicine consultations, Joaquin E. Cigarroa, MD, a cardiologist at Oregon Health & Science University in Portland, was able to establish relationships with 4 new patients and their families, conduct a physical examination using an electronic stethoscope, review the patients’ laboratory results, and develop a care plan. The best part was that the patients, who all live in coastal Lincoln City, Oregon, were able to skip the 3-hour drive to Portland through traffic and often fog. Figure 1. A mock telecardiology consult. Increasingly, cardiologists across the country are leveraging technology to provide remote care, whether through virtual visits and exams, consultations, or continuous monitoring using a growing array of implantable or wearable devices. “Patients love it,” said Cigarroa. They only need to make the trek to Portland when they need advanced diagnostics or procedures. For Cigarroa and his colleagues at Oregon Health & Science University, providing such off-site care is “critical to providing patient-centered care,” he said. He explained that ≈60% of the patients admitted to the cardiovascular service line at Oregon Health & Science University’s hospital are from outside of the Portland metro area, and many are from rural regions of the state. He and his colleagues have increasingly made use of Oregon Health & Science University’s telemedicine portals, which can even be used to perform echocardiograms, to care for patients closer to their homes. “It’s compassionate to the patient and their family to maintain them in their community and only transfer them if they need procedural or …

Reducing Emergency Room Visits and Unplanned Hospital Admissions During Radiation Therapy in Patients With Head and Neck Cancer

Reducing Emergency Room Visits and Unplanned Hospital Admissions During Radiation Therapy in Patients With Head and Neck Cancer

Telemetric monitoring reduces visits to the emergency room and cost of care in patients with chronic heart failure

Abstract Background Tele-cardiology is the use of information technologies that help prolong survival, improve quality of life and reduce costs in health care. Heart failure is a chronic disease that leads to high care costs. Objective To determine the effectiveness of telemetric monitoring for controlling clinical variables, reduced emergency room visits, and cost of care in a group of patients with heart failure compared to traditional medical consultation. Material and methods A randomised, controlled and open clinical trial was conducted on 40 patients with heart failure in a tertiary care centre in north-western Mexico. The patients were divided randomly into 2 groups of 20 patients each (telemetric monitoring, traditional medical consultation). In each participant was evaluated for: blood pressure, heart rate and body weight. The telemetric monitoring group was monitored remotely and traditional medical consultation group came to the hospital on scheduled dates. All patients could come to the emergency room if necessary. Results The telemetric monitoring group decreased their weight and improved control of the disease ( p = 0.01). Systolic blood pressure and cost of care decreased (51%) significantly compared traditional medical consultation group ( p > 0.05). Admission to the emergency room was avoided in 100% of patients in the telemetric monitoring group. Conclusion In patients with heart failure, the telemetric monitoring was effective in reducing emergency room visits and saved significant resources in care during follow-up.

El seguimiento telemétrico disminuye la visita a la sala de urgencias y coste de atención en enfermos con insuficiencia cardíaca crónica

BackgroundTele-cardiology is the use of information technologies that help prolong survival, improve quality of life and reduce costs in health care. Heart failure is a chronic disease that leads to high care costs. ObjectiveTo determine the effectiveness of telemetric monitoring for controlling clinical variables, reduced emergency room visits, and cost of care in a group of patients with heart failure compared to traditional medical consultation. Material and methodsA randomized, controlled and open clinical trial was conducted on 40 patients with Heart failure in a tertiary care centre in north-western Mexico. The patients were divided randomly into 2 groups of 20 patients each (telemetric monitoring, traditional medical consultation). In each participant was evaluated for: blood pressure, heart rate and body weight. The telemetric monitoring group was monitored remotely and traditional medical consultation group came to the hospital on scheduled dates. All patients could come to the emergency room if necessary. ResultsThe telemetric monitoring group decreased their weight and improved control of the disease (P=.01). Systolic blood pressure and cost of care decreased (51%) significantly compared traditional medical consultation group (P>.05). Admission to the emergency room was avoided in 100% of patients in the telemetric monitoring group. ConclusionIn patients with heart failure, the telemetric monitoring was effective in reducing emergency room visits and saved significant resources in care during follow-up.