Personalized Care Plans: Are They Effective in Decreasing ED Visits and Health Care Expenditure Among Adult Super-Utilizers?

Bergenstal, Twyla Dawn; Reitsema, Jeffrey; Heppner, Peggy; Geerts, Joyce; Cho, Amy; Smallheer, Benjamin

doi:10.1016/j.jen.2019.09.001

Cited by 6 publications

(8 citation statements)

References 9 publications

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“…An observational study exploring nursing complexity as described by nursing diagnoses revealed a statistically significant perfect linear association between the number of nursing diagnoses/problems and both the length of stay and the morality rate ( ρ = 1.00; P < .001) 14 . Furthermore, individualized nursing care plans in the emergency care setting resulted in statistically significant decreases in total charges generated ( Z value = −5.871; P < .001) among individuals who frequently use emergency department services 15 …”

Section: Literature Reviewmentioning

confidence: 94%

“…14 Furthermore, individualized nursing care plans in the emergency care setting resulted in statistically significant decreases in total charges generated (Z value = −5.871; P < .001) among individuals who frequently use emergency department services. 15 Adereti and Olaogun 4 as well as Rabelo-Silva et al 16 found the quality of nursing care plans using standardized nursing language (SNL) in an electronic health record (EHR) format was higher compared with paper care plans. Both authors used the Muller-Staub instrument Quality of Diagnoses, Interventions and Outcomes to measure nursing care plan quality.…”

Section: Literature Reviewmentioning

confidence: 99%

“…13 Many studies supported the use of SNL in the development of individualized nursing care. [9][10][11][12][13][14][15][16][18][19][20][21][22][23][24][25] Other factors mentioned in the literature that impact the development of individualized nursing care plans includes staff training, nursing attitudes, and the use of electronic documentation. [19][20][21][22][23]…”

Section: Literature Reviewmentioning

confidence: 99%

“…Without SNL, there are missed opportunities to mine the large amount of complex data generated by nursing care plans 18 . Generally, the studies found in the literature reported that individualized care plans were related to improvements in patient outcomes, 8–16,18–21 although not all reached a level of statistical significance 13 . Many studies supported the use of SNL in the development of individualized nursing care 9–16,18–25 .…”

Section: Literature Reviewmentioning

confidence: 99%

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Implementing a Care Plan System in a Community Hospital Electronic Health Record

Russell¹,

McNeill²

2022

CIN: Computers, Informatics, Nursing

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Nursing care plans, the result of the nursing process, are important because they guide quality patient care, define the nurse's role in patient treatment, and support patient specific nursing interventions. Nurse leaders at a community hospital identified that 70% of hospitalized patients shared the same three nursing problems and three-day resolution target dates. This quality improvement project involved the implementation of a nursing care plan system within the organization's existing electronic health record platform that supported the development of individualized plans. The implementation included a) integration of care plan activities into the nursing workflow, b) adoption of a standardized nursing language to provide structure nursing care plan data capture and reporting, c) configuration of the electronic health record to recommend patient data-driven care plan problems based on nursing assessment documentation; and d) trended care plan data to identify problem patterns within the patient population. A postimplementation audit indicated a 130% improvement in achieving individualized care plans within 24 hours of admission.

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Section: Literature Reviewmentioning

confidence: 94%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Implementing a Care Plan System in a Community Hospital Electronic Health Record

Russell¹,

McNeill²

2022

CIN: Computers, Informatics, Nursing

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“…Now the entire emergency care system has begun to revolutionize standardized care processes and payment systems that account for social determinants of health. For example, in this issue of JEN, Bergenstal et al 49 developed personalized care plans to reduce the ED utilization of super-utilizers, or patients who were seen in the emergency department 4 or more times in the last year with the same presenting problem. In the next 50 years, I envision emergency nurses will continue to have key leadership roles to incorporate novel interventions into routine acute care encounters and personalized super-utilizer care plans.…”

Section: The Specialty Of Emergency Nursing As a Revolutionmentioning

confidence: 99%

On Evolutions and Revolutions in Emergency Care: Commemorating the Emergency Nurses Association’s 50th Anniversary

Castner¹

2020

Journal of Emergency Nursing

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Association of Hospital Incentive Care Management Partnerships for Uninsured Patients With Emergency Department Utilization

et al. 2023

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ImportanceThe South Carolina (SC) Healthy Outcomes Plan (HOP) program aimed to expand access to health care to individuals without insurance; it remains unknown whether there is an association between the SC HOP program and emergency department (ED) use among patients with high health care costs and needs.ObjectivesTo determine whether participation in the SC HOP was associated with reduced ED utilization among uninsured participants.Design, Setting, and ParticipantsThis retrospective cohort study included 11 684 HOP participants (ages 18-64 years) with at least 18 months of continuous enrollment. Generalized estimating equations and segmented regression of interrupted time-series analyses of ED visits and charges were conducted from October 1, 2012, to March 31, 2020.ExposuresTime intervals related to the HOP were 1 year before and 3 years after participation.Main Outcomes and MeasuresED visits per 100 participants per month and ED charges per participant per month overall and by subcategory.ResultsThe mean (SD) age of the 11 684 participants in the study was 45.2 (10.9) years; 6293 (54.5%) were women; 5028 (48.4%) were Black participants and 5189 (50.0%) were White participants. Over the study period, the mean (SE) number of ED visits decreased by 44.1%, from 48.1 (5.2) to 26.9 (2.8) per 100 participants per month. The mean (SE) ED charges were reduced to $858 ($46) per participant per month, a decrease from a mean (SE) of $1583 ($88) per participant per month 1 year before HOP implementation. There was an immediate level decrease of 40% (relative risk [RR], 0.61; 99.5% CI, 0.48-0.76; P &lt; .001) from the preenrollment period, with a sustained reduction trend of 8% (RR 0.92; 99.5% CI, 0.89-0.95; P &lt; .001) during the postenrollment period. A level change for ED charges was detected, at a decrease of 40% (RR 0.60; 99.5% CI, 0.47-0.77; P &lt; .001) directly after HOP enrollment with a subsequent downward trend of 10% (RR 0.90; 99.5% CI, 0.86-0.93; P &lt; .001) for the postenrollment period.Conclusions and RelevanceIn this retrospective cohort study, proportions and charges of ED visits by uninsured patients saw immediate and sustained decreases after HOP enrollment. Reducing ED charges may have been driven by decreasing the ED as the primary point of patient care, especially for high-frequency users. These findings have implications for other nonexpansion states seeking to maximize uninsured compensation for low-income populations through improved outcomes.

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Personalized Care Plans: Are They Effective in Decreasing ED Visits and Health Care Expenditure Among Adult Super-Utilizers?

Cited by 6 publications

References 9 publications

Implementing a Care Plan System in a Community Hospital Electronic Health Record

Implementing a Care Plan System in a Community Hospital Electronic Health Record

On Evolutions and Revolutions in Emergency Care: Commemorating the Emergency Nurses Association’s 50th Anniversary

Association of Hospital Incentive Care Management Partnerships for Uninsured Patients With Emergency Department Utilization

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