A “Patch” to the <scp>NYU</scp> Emergency Department Visit Algorithm

Johnston, Marla; Allen, Lindsay; Melanson, Taylor; Pitts, Michael

doi:10.1111/1475-6773.12638

Cited by 74 publications

(78 citation statements)

References 10 publications

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“…Lastly, there is a sizeable proportion of patients with ED visits unclassified by the NYU ED visit severity algorithm (14.5%) which were not further characterized. This is similar to other studies using this algorithm and a limitation to using this approach (Johnston, Allen, Melanson, & Pitts, 2017).…”

Section: Discussionsupporting

confidence: 90%

Emergency department utilization by people living with HIV released from jail in the US South

Puing

Rich

et al. 2020

Health Justice

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Background: Incarceration is disruptive to HIV care, often resulting in poor retention in care for people living with HIV (PLWH) after jail release. This gap in HIV care might result in potentially preventable emergency department (ED) utilization. We analyzed demographic, incarceration, socioeconomic and clinical data for PLWH released from the Dallas County Jail to the community (1450 incarcerations, 1155 unique individuals) between January 2011 and November 2013. Results: The study population consisted of predominantly men (77%), with a mean age of 39 years, 67% were black and 14% were Hispanic; half of the releasees visited the ED at least once during the first-year post-jail. In adjusted analyses, female gender, family awareness of HIV status, serious mental illness, and late engagement to HIV care were significantly associated with higher ED utilization. Compared to the general Dallas population, PLWH released from jail had a 5-fold higher proportion of ED visits classified as related to substance use or mental health. Conclusions: Further efforts are needed to improve the transition from incarceration to community-based HIV care, substance use disorder treatment and mental health services, and to directly address re-engagement in HIV care for out-of-care PLWH who visit the ED.

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Section: Discussionsupporting

confidence: 90%

Emergency department utilization by people living with HIV released from jail in the US South

Puing

Rich

et al. 2020

Health Justice

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“…Common factors for inappropriate ED use include greater trust in the hospital than in primary care [48] or greater convenience [38] and time savings [73,74]. Previous Billings/NYU-ED classi cation algorithm [40,75] designed to monitor different groups' ambulatory care sensitive conditions [76] or safety-net role of ED use [40,77]. One Taiwanese national validation study disclosed that an increase in the availability of ambulatory care physicians or facilities that did not decrease non-emergency treatment in ED use [78].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use - A nationwide long-term observational study in Taiwan

Lin

Lee²

2020

Preprint

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Background: The goal of this study was to examine the effect of hospital emergency department (ED) regionalization policy and the categorization of hospital emergency care policy (categorization policy) on patient appropriate ED use.Methods: We conducted an observational study of the effect of emergency care policy intervention on patients' visits. Seven years of data from the Taiwan National Health Insurance Research Database (NHIRD) were examined. Taiwan implemented a nationwide three-tiered hospital ED regionalization and categorization policies in 2007 and 2009, respectively. There were 1,835,860 ED visits found among one million random samples from the NHIRD between 2005 and 2011. ED visits were categorized by the modified New York University ED algorithm. A time series analysis was performed to examine the change in the rate of appropriate ED use after the policy took effect.Results: Total ED visits increased by 10.7% from 2005 to 2011. Average appropriate ED visit rate was 66.9% during the policy intervention. The trend in the appropriate ED visit rate showed no significant policy effect.Conclusions: Provider side of regionalization and categorization policies did increase emergency care accessibility. However, regionalization and categorization policies no significant effect on patient appropriate ED use.

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“…The updated version of the algorithm includes additional categories for injury, mental health, alcohol use, and drug use. 23 Based on these classifications, Billings et al 24 compiled a set of probabilistic weights that were applied to ED discharge data using the primary discharge ICD-10 diagnosis codes to determine the percentage of ED use attributable to each category. ED visits with diagnosis codes not mapped to any of the 8 categories were assigned to the "unclassified" category.…”

Section: Identifying Preventable Acute Carementioning

confidence: 99%

High-Cost Patients and Preventable Spending: A Population-Based Study

Oliveira

Cheng

Chan

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Although high-cost (HC) patients make up a small proportion of patients, they account for most health system costs. However, little is known about HC patients with cancer or whether some of their care could potentially be prevented. This analysis sought to characterize HC patients with cancer and quantify the costs of preventable acute care (emergency department visits and inpatient hospitalizations). Methods: This analysis examined a population-based sample of all HC patients in Ontario in 2013. HC patients were defined as those above the 90th percentile of the cost distribution; all other patients were defined as non–high-cost (NHC). Patients with cancer were identified through the Ontario Cancer Registry. Sociodemographic and clinical characteristics were examined and the costs of preventable acute care for both groups by category of visit/condition were estimated using validated algorithms. Results: Compared with NHC patients with cancer (n=369,422), HC patients with cancer (n=187,770) were older (mean age 70 vs 65 years), more likely to live in low-income neighborhoods (19% vs 16%), sicker, and more likely to live in long-term care homes (8% vs 0%). Although most patients from both cohorts tended to be diagnosed with breast, prostate, or colorectal cancer, those with multiple myeloma or pancreatic or liver cancers were overrepresented among the HC group. Moreover, HC patients were more likely to have advanced cancer at diagnosis and be in the initial or terminal phase of treatment compared with NHC patients. Among HC patients with cancer, 9% of spending stemmed from potentially preventable/avoidable acute care, whereas for NHC patients, this spending was approximately 30%. Conclusions: HC patients with cancer are a unique subpopulation. Given the type of care they receive, there seems to be limited scope to prevent acute care spending among this patient group. To reduce costs, other strategies, such as making hospital care more efficient and generating less costly encounters involving chemotherapy, should be explored.

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A “Patch” to the NYU Emergency Department Visit Algorithm

Abstract: Our patch significantly improves the precision and usefulness of the most commonly used ED visit classification system in health services research.

Cited by 74 publications

References 10 publications

Emergency department utilization by people living with HIV released from jail in the US South

Emergency department utilization by people living with HIV released from jail in the US South

Effectiveness of Hospital Emergency Department Regionalization and Categorization Policy on Appropriate Patient Emergency Care Use - A nationwide long-term observational study in Taiwan

High-Cost Patients and Preventable Spending: A Population-Based Study

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