A value-based comparison of the management of respiratory diseases in walk-in clinics and emergency departments

Abstract

Objectives Our aim was to compare some of the health outcomes and costs associated with value of care in emergency departments (ED) and walk-in clinics for ambulatory patients presenting with an acute respiratory disease. Methods A health records review was conducted from April 2016 through March 2017 in one ED and one walk-in clinic. Inclusion criteria were: (i) ambulatory patients at least 18 years old, (ii) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Primary outcome was the proportion of patients returning to any ED or walk-in clinic within three and seven days of the index visit. Secondary outcomes were the mean cost of care and the incidence of antibiotic prescription for URTI patients. The cost of care was estimated from the Ministry of Health's perspectives using time-driven activity-based costing. ResultsThe ED group included 170 patients and the walk-in clinic group 326 patients. The return visit incidences at three and seven days were, respectively, 25.9% and 38.2% in the ED vs. 4.9% and 14.7% in the walk-in clinic (adjusted relative risk (arr) of 4.7 (95% CI 2.6-8.6) and 2.7 (1.9-3.9)). The mean cost ($Cdn) of the index visit care was 116.0 (106.3-125.7) in the ED vs. 62.5 (57.7-67.3) in the walk-in clinic (mean difference of 56.4 (45.7-67.1)). Antibiotic prescription for URTI was 5.6% in the ED vs. 24.7% in the walk-in clinic (arr 0.2, 0.01-0.6). Conclusions This study is the first in a larger research program to compare the value of care between walk-in clinics and the ED. The potential advantages of walk-in clinics over EDs (lower costs, lower incidence of return visits) for ambulatory patients with respiratory diseases should be considered in healthcare planning. KeywordsValue of care • Health outcomes • Respiratory diseases • Outpatient visit • Emergency department • Return visits • Cost of care The results of this study were presented as a Poster at the annual conference of the Canadian Association of Emergency Physicians (CAEP), in Québec on May 30, 2022.

Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada

“…A parallel study following the same methodology was performed concurrently for the adult population and was previously published. 14 …”

“…A parallel study following the same methodology was performed concurrently for the adult population and was previously published. 14 Study setting and design A retrospective cohort study was conducted for the fiscal year 1 April 2016 to 31 March 2017 in one ED and one walk-in clinic in Québec city (Canada). The participating ED is a paediatric tertiary care centre where an average of 34 000 children are seen every year.…”

Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study

“…In addition, 2 patient partners met with us regularly and provided helpful comments to make our research plan patient-centered. From previous studies, our team was able to perform life cycle assessment [76][77][78][79][80] and cost-effectiveness [60,61,81,82] measures. This previous work will help with the proposed study.…”