An Emergency Room Decision-Support Program That Increased Physician Office Visits, Decreased Emergency Room Visits, and Saved Money

Abstract

The objective of this study was to evaluate an Emergency Room having a Decision-Support (ERDS) program designed to appropriately reduce ER use among frequent users, defined as 3 or more visits within a 12-month period. To achieve this, adults with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) were eligible to participate in the program. These included 7070 individuals who elected to enroll in the ERDS program and an equal number of matched nonparticipants who were eligible but either declined or were unreachable. Program-related benefits were estimated by comparing the difference in downstream health care utilization and expenditures between engaged and not engaged individuals after using propensity score matching to adjust for case mix differences between these groups. As a result, compared with the not engaged, engaged individuals experienced better care coordination, evidenced by a greater reduction in ER visits (P=0.033) and hospital admissions (P=0.002) and an increase in office visits (P<0.001). The program was cost-effective, with a return on investment (ROI) of 1.24, which was calculated by dividing the total program savings ($3.41 million) by the total program costs ($2.75 million). The ROI implies that for every dollar invested in this program, $1.24 was saved, most of which was for the federal Medicare program. In conclusion, the decrease in ER visits and hospital admissions and the increase in office visits may indicate the program helped individuals to seek the appropriate levels of care.

Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review

“…Twenty-one NCBA studies, [12][13][14][15][16][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] six RCTs, 17,[41][42][43][44][45] and four CBA studies [46][47][48][49] examined interventions targeting adult frequent ED users. The studies were published between 1985 and 2014 (median publication year = 2010; IQR = 2006 to 2013).…”

“…The studies were published between 1985 and 2014 (median publication year = 2010; IQR = 2006 to 2013). Most (n = 23) were published in peer-reviewed journals, [12][13][14][15][16][17][25][26][27][28][29][30][35][36][37][38][39]41,[44][45][46][47][48][49] five were scientific conference abstracts, [31][32][33][34]40 and two were protocols for planned RCTs. 42,43 Authors of primary studies were mainly from the United States.…”

“…42,43 Authors of primary studies were mainly from the United States. 12,13,15,25,27,31,32,34,36,37,[39][40][41]45,46,48,49 Other countries represented were Canada, 38,43 the United Kingdom, 16,26,33 Australia, 14,30 Sweden, 17,28,44,47 Scotland, 35 Taiwan, 29 and Switzerland. 42 Overall, studies included a general frequent user population; however, some focused their inclusion on subgroups with psychiatric, mental health or substance abuse comorbidities, 25,26,36,39,43 homeless, low income, unemployed or uninsured/underinsured patients, 13 41 Additional definitions were more than three visits in 6 months, 44 10 visits in 6 months, 35 three visits in 1 month, 37 and three or more visits in 72 hours.…”

“…Interventions implemented were case management (n = 18), diversion strategies to nonurgent care (n = 3), 31,47,48 printout case notes (n = 1), 17 and social work home visits (n = 1). 27 Case management involved multidisciplinary teams, including physicians, nurses, psychologists, social workers, and/or housing and community resource liaisons, who developed tailored care strategies for patients and linked them to necessary services.…”

“…One study 27 arranged social work home visits to identify patient needs. All but seven studies 25,30,31,34,43,48,49 explicitly defined frequent ED use and followed ED visits at a single institution rather than at multiple centers.…”