Nonurgent Care in the Emergency Department: Can We Save by Shifting the Site of Care?

Florence, Curtis S.

doi:10.1016/j.annemergmed.2005.01.001

Cited by 9 publications

(8 citation statements)

References 5 publications

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“…The reason this is important is that estimating the marginal costs of nonurgent ED care helps to determine whether cost savings would be achieved by shifting nonurgent care from the ED to another site. Generally it is assumed that it would, but it has not yet been clearly demonstrated that moving nonurgent care from an ED to a primary care setting would result in markedly less, or even somewhat less cost than providing that care in an ED (Florence, 2005;Kellerman, 2005). Also, it is here in the discussion of costs of NUEDU that the distinction between "cost" and "charge" is critically important.…”

Section: Nuedu: Costs Charges and Paymentsmentioning

confidence: 97%

“…This is the basis of economy of scale. In the scope of all ED care the costs for nonurgent care are often defined as marginal costs because nonurgent care is provided only after all other more urgent care is provided, and it is the more urgent care for which the initial investments were made Gill, 1994;Williams, 1996;Florence, 2005;Bamezai, 2005.) It has been argued that because the marginal cost for nonurgent ED care is relatively low, NUEDU actually benefits some hospital EDs.…”

Section: Nuedu: Costs Charges and Paymentsmentioning

confidence: 99%

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The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

DeWood¹

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DEDICATIONThis work is dedicated to my family. My husband, Gary DeWood, has provided far more encouragement and support throughout the duration of this project than either of us thought would be necessary, and has done so with grace and forbearance. My children, Patricia, Dale, and Kathryn, made many sacrifices and contributions that were material to my being able to be in school, for which I am more grateful than I can express. While it may be impossible to quantify the benefits of prayer, I am certain that the maximum of those benefits have been bestowed on me due to the fact that my mother, Alice Davis, has made countless petitions heavenward on my behalf. (Any answering of prayers that has occurred is because my mother deserves to have her prayers answered, not because I do. In any case, because of the probable reduction in requests for help, I dare say even God is relieved that my dissertation is finally complete.) The example set by my late father, Dr. Dale Davis, whose work as an adult PhD candidate I remember, exhorted me to sustain my efforts during times when it seemed that this enterprise was ill-advised for anyone who could be otherwise gainfully employed. iv ACKNOWLEDGEMENTSFirst and foremost, I thank Dr. James Vaden for being my advocate, providing encouragement, and for being a mentor without peer. I do not know by what luck it is that I was able to find such a friend.I would also like to thank all the faculty members who gave me instruction and guidance. In particular I appreciate the efforts of my committee members, Drs. Lawrence Brown, Cyril Chang, Joy Clay, Doug Imig, and Junling Wang, but most especially for those of Dr. Lawrence Brown, who had the unenviable task of assuming chairmanship of my dissertation committee late in the game. No one knows better than I do that accomplishing all that is required to obtain a Ph.D. cannot be done alone.v ABSTRACT Purpose. The purpose of this study is to examine the influence of patientperceived provider availability on nonurgent emergency department use (NUEDU). The study population consists of a nationally-representative population of non-elderly adults who were continuously privately insured (CPI) for at least a year before an emergency department visit that was determined to be nonurgent, and who reported having a regular source of care (RSC).Methods. Data were obtained from a nationally-representative longitudinal survey, the Medical Expenditure Panel Survey (MEPS). The classification of ED visits as nonurgent was based on patient report using a method developed for this study. Patient-perceived provider availability was based on patient report of how difficult it was to contact their RSC by phone for medical advice during office hours (Regular Hours Contact), how difficult it was to reach their RSC after hours in case of an urgent problem (After Hours Contact), and whether their RSC had office hours at night or on weekends (Night or Weekend Hours). Multiple logistic regression analysis was used to determine whether the patient-reported provider ava...

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Section: Nuedu: Costs Charges and Paymentsmentioning

confidence: 97%

Section: Nuedu: Costs Charges and Paymentsmentioning

confidence: 99%

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

DeWood¹

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“…Una ética del cuidado presente en la medicina para acompañar a las personas en esta etapa final, llegue ésta a través del camino que sea, por accidente, por vejez, por enfermedad, nos ayudaría a afrontar con dignidad la muerte, por lo que una formación especifica 136 , tanto técnica como ética, debería de ser una prioridad en este campo. En este sentido, Bonete (2002) reclama la creación de una nueva responsabilidad: Ensayo de una ética para la civilización tecnológica.…”

Section: La Emergencia De Morir Bien Atendidounclassified

“…Barcelona, 1997. 136 Destacar el interesante trabajo realizado sobre este aspecto de Enrique Bonete (2002), titulado: Ética de la muerte: de la bioética a la tanatoética, donde sienta las bases para esta nueva disciplina desde el punto de vista teórico y práctico, desligándola de la bioética, que considera, debería delimitarse en torno a las reflexiones y dilemas en el origen de la vida. A lo largo de su trabajo desarrolla los contenidos principales para esta nueva disciplina.…”

Section: La Emergencia De Morir Bien Atendidounclassified

La narrativa biográfica: Opción metodológica para investigar la relación enfermera-personas viviendo con VIH/SIDA

Mesa

Silva²

2012

Index Enferm

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DedicatoriaA Blas e Isabel, mis padres, por apoyarme en seguir avanzando.A Fernando y Eva, por ayudarme a que este proceso haya sido en algunos momentos hasta divertido.A Eva, a Max y Jordi por los ratos que hemos pasado a la sombra de la parra. Maria Francisca Jimenez Herrera ISBN:978-84-692-9054-5/DL:T-2066 UNIVERSITAT ROVIRA I VIRGILI CONSTRUCCIÓN DE LA ÉTICA ASISTENCIAL DEL CUIDAR EN URGENCIAS Y EMERGENCIAS Maria Francisca Jimenez Herrera ISBN:978-84-692-9054-5/DL:T-2066 Agradecimientos A mi director de tesis y amigo, Pep Canals, por dedicarme su tiempo y su sabiduría para conseguir que este trabajo se presente hoy aquí y a Oriol Romaní por ponerle en mi camino. UNIVERSITAT ROVIRA I VIRGILI CONSTRUCCIÓN DE LA ÉTICA ASISTENCIAL DEL CUIDAR EN URGENCIAS Y EMERGENCIASA Carme Nogués por estar siempre cuando la he necesitado.A mis amigas y compañeras de la Escuela de Enfermería que han sabido tener paciencia ante mis incertidumbres.A mis amigos y amigas, a los que no puedo enumerar porque seguro que me dejaría a alguien y eso sería muy injusto, ya que he recibido apoyo de todos ellos desde la sinceridad y el cariño.A mis compañeras y compañeros de urgencias por el tiempo que me han dedicado y la ilusión que han demostrado para que este trabajo vea la luz.A mis compañeras y compañeros de emergencias que siempre me han entendido y aceptado con mis cosas de la ética.A todas aquellas personas que en mayor o menor medida se han cruzado en micamino durante la elaboración de este trabajo y me han ayudado a ver el mundo de otra forma. IntroducciónCon la realización de esta tesis doctoral nos proponemos analizar una realidad concreta que se lleva a cabo dentro del panorama sanitario en unos espacios concretos como son los servicios de urgencias y los servicios de emergencias, planteados aquellas cuestiones que derivadas de la práctica pueden ser consideradas dentro del amplio mundo de la bioética.Este trabajo es el resultado de diferentes experiencias tanto docentes como asistenciales ya que siempre he tenido una afinidad concreta con el desarrollo de la ética asistencial desde la perspectiva teórica como de la práctica a través de la experiencia de trabajar como enfermera en urgencias y emergencias y como profesora de ética en la Escuela de Enfermería de la Universidad Rovira i Virgili, por lo que todos estos aspectos han determinado la elección de este tema de estudio así como los diferentes enfoques teóricos y metodológicos que he utilizado para reflejar esta realidad concreta y posteriormente analizarla.He trabajado como enfermera asistencial en diferentes servicios de urgencias y emergencias de la provincia de Tarragona y en la actualidad trabajo como profesora de asignaturas relacionadas con la ética en el ámbito de la enfermería, entre medias me forme en la disciplina de la antropología social y cultural así como de la bioética que me han ayudado a entender y mirar la realidad desde una perspectiva diferente a la de la biomedicina, partiendo de que la simbiosis entre la antropología y la enfermería constituyen...

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“…From the health services research perspective, most agree that primary care provided in the doctor's office costs less, and emergency department (ED) services and hospital admissions are more expensive. The inappropriate use of health services such as non‐emergent ED care not only waste more resources, but also cause delivery systems like hospitals to operate inefficiently [1,2].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing inappropriate use of ED visits among type 2 diabetics in an evidence‐based management programme

Chiou

Campbell

Myers

et al. 2010

Evaluation Clinical Practice

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The study suggests that inappropriate use of the ED among diabetic patients in an evidence-based management programme is more likely to occur among African American, patients with insurance coverage and those seeking care in larger hospitals. Reinforcing the regular use of clinic services for diabetes management, providing clinic access in off-hours, and engaging the health plans in providing incentives for more appropriate use of the ED might reduce inappropriate ED visits. Notably, uninsured patients with diabetes from HCSD were more efficient users of the ED.

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Nonurgent Care in the Emergency Department: Can We Save by Shifting the Site of Care?

Cited by 9 publications

References 5 publications

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

La narrativa biográfica: Opción metodológica para investigar la relación enfermera-personas viviendo con VIH/SIDA

Factors influencing inappropriate use of ED visits among type 2 diabetics in an evidence‐based management programme

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