CARES: A Community-wide Collaboration Identifies Super-utilizers and Reduces Their 9-1-1 Call, Emergency Department, and Hospital Visit Rates

Abstract

When health systems in a geographic area share data, they are better able to recognize patterns of overuse, and address them properly. This study demonstrated that a collaborative 90-day intervention identifying super-utilizers reduced the monthly rate of 9-1-1 calls, ED visits, and hospital admissions.

Systematic review of blue-light service collaboration for community health and well-being

“…The second included report was by Bronsky et al (2017) based in Colorado, United States, and focussed on a subset of individuals who were "super-utilizers" of ED services. A community-wide collaboration program, Community Assistance Referral and Education Services (CARES), comprised several providers who interacted at different points during each patient's intervention according to individual needs.…”

“…Further iterative grey literature searching of many more thousands of potential documents and references resulted in 23 reports being retrieved, and, following eligibility assessment, three potential reports of interest were included (Bronsky et al, 2017;Elias et al, 2021;Emergency Services Collaboration Working Group, 2016). Contact with key experts and via Twitter elicited a small number of responses but did not yield any relevant reports.…”

“…The first described a specific program to respond to the needs of vulnerable older people with an alternative to hospital admission (Elias et al, 2021). The second was a specific community program improving outcomes for people who frequently use Emergency Departments (EDs) (Bronsky et al, 2017). The third report was a "National Overview" of several projects and initiatives across England and Wales (Emergency Services Collaboration Working Group, 2016), which summarized activities by six main headings: "First response and co-responding," "Demand management and rationalisation," "Shared estates and assets," "Joint control rooms," "Wider collaboration," and "Strategic alliances and partnerships", reported in more detail in Table II.…”

“…Two included studies were empirical real-world observational studies, one using a case study approach of data collected via quality improvement and service evaluation (Elias et al, 2021) and the other a retrospective program evaluation (Bronsky et al, 2017). We assessed these studies using the ArRoWS critical appraisal tool (Coles et al, 2021) the Assessment of Real-World Observational Studies (ArRoWS), finding some methodological issues, and Elias et al offered more robust findings (see Table III).…”

Interventions to Decrease Use in Prehospital and Emergency Care Settings Among Super-Utilizers in the United States: A Systematic Review

“…These factors are considered further downstream in the WHO framework for the social determinants of health. Notably, the case management studies authored by Bronsky et al (2017) and Nossel et al (2016) included intervention components aimed at the more upstream structural determinants of occupation and education by offering referrals for vocational training. However, it is important to note that many of the services addressing social factors were only provided to patients on an “as needed” basis, and may not accurately depict how the intervention was delivered to most patients.…”