Revisit Rates and Associated Costs After an Emergency Department Encounter

Duseja, Reena; Bardach, Naomi S.; Lin, Grace A.; Yazdany, Jinoos; Dean, Mitzi L.; Clay, Theodore H.; Boscardin, W. John; Dudley, R. Adams

doi:10.7326/m14-1616

Cited by 112 publications

(87 citation statements)

References 15 publications

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“…This study is limited to one hospital and significant interhospital variation exists. 1 We are working with other healthcare providers to see if similar patterns hold. Our study demonstrated that there are distinct differences in the determinants for ED revisits among frequent patients and other patients.…”

Section: Discussion and Recommendationsmentioning

confidence: 90%

“…1 Furthermore, the passage of the Affordable Care Act penalizes institutions exceeding set 30-day revisit rates. 2 Many of these ED revisits are seen as preventable, thus a deeper understanding of the phenomenon can help provide streamlined and quality emergency care.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Research on characterizing revisit rates has many facets, ranging from the construction of risk indices 4,6 to examining statistical behavior 1,3,7-9 and constructing predictive models using machine learning principles. 10,11 Both 30 days 1,3,4,11 and 72 hours 7,8,10 have been used as cutoff points for whether a visit before a given ED encounter is considered a revisit. Such studies often treat insurance type as a factor; as such, there is not much information on the specific behavior of the space of Medicaid patients.…”

Section: Introductionmentioning

confidence: 99%

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Understanding Emergency Department 72-Hour Revisits Among Medicaid Patients Using Electronic Healthcare Records

2015

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Electronic Healthcare Records (EHRs) have the potential to improve healthcare quality and to decrease costs by providing quality metrics, discovering actionable insights, and supporting decision-making to improve future outcomes. Within the United States Medicaid Program, rates of recidivism among emergency department (ED) patients serve as metrics of hospital performance that help ensure efficient and effective treatment within the ED. We analyze ED Medicaid patient data from 1,149,738 EHRs provided by a hospital over a 2-year period to understand the characteristics of the ED return visits within a 72-hour time frame. Frequent flyer patients with multiple revisits account for 47% of Medicaid patient revisits over this period. ED encounters by frequent flyer patients with prior 72-hour revisits in the last 6 months are thrice more likely to result in a readmit than those of infrequent patients. Statistical L1-logistic regression and random forest analyses reveal distinct patterns of ED usage and patient diagnoses between frequent and infrequent patient encounters, suggesting distinct opportunities for interventions to improve efficacy of care and streamline ED workflow. This work forms a foundation for future development of predictive models, which could flag patients at high risk of revisiting.

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Section: Discussion and Recommendationsmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Understanding Emergency Department 72-Hour Revisits Among Medicaid Patients Using Electronic Healthcare Records

2015

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“…To date, focus on care transitions, post-hospital outpatient care, and corresponding outcomes in the USA has largely been applied to vulnerable older adults discharged from inpatient stays 23 55-58 and to a smaller extent, emergency department stays. 22 34 41 Little attention has been directed to improving outcomes after observation services. Our results suggest that strategies designed to integrate care for patients after discharge from emergency department stays and inpatient stays, such as facilitating access to outpatientproviders, 59 early and longitudinal follow-up, 56 60 61 timely transmittal of information from hospitals to outpatient teams, 62 outpatient availability of care management services, 62 63 multidisciplinary team based care, 64 65 and home visits 66 may also warrant consideration for patients after observation stays, as greater than 90% are discharged home.…”

Section: Discussionmentioning

confidence: 99%

“…6 20 21 This gap in knowledge about observation stays contrasts with the extensive literature describing outcomes after discharge from emergency department treatment-and-discharge stays and inpatient stays. [22][23][24][25] As a result, outstanding questions remain about rates of occurrence of hospital revisits, including emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, and any hospital revisit after discharge from index observation stays; rates of occurrence of death after discharge from index observation stays; potential differences in revisit and mortality outcomes after discharge from index observation stays compared with outcomes after discharge from index emergency department treatment-and-discharge stays and index inpatient stays; and changes in outcomes over time. These estimates are critical to understanding the vulnerabilities experienced by patients after discharge form observation services and can guide the design of hospital and health system transitional care interventions to mitigate these risks.…”

Section: What This Study Addsmentioning

confidence: 99%

Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study

Dharmarajan

Bierlein

et al. 2017

BMJ

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Objective To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays. Design Retrospective cohort study. Setting 4750 hospitals in the USA. Participants Nationally representative sample of Medicare fee for service beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11. Main outcome measures Rates of emergency department treatment-and-discharge stays, observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from index observation stays. Rates were compared with corresponding outcomes within 30 days of discharge from both index emergency department treatment-and-discharge stays and index inpatient stays. Results Among 363 037 index observation stays resulting in discharge from 2006-11, 30 day rates of emergency department treatment-and-discharge stays were 8.4%, repeat observation stays were 2.9%, inpatient stays were 11.2%, any hospital revisit was 20.1%, and death was 1.8%. Of all revisits, 49.7% were for inpatient stays. Revisit rates for emergency department treatment-and-discharge stays, repeat observation stays, and any hospital revisit increased from 2006-11 (P<0.001 for trend), while 30 day rates of inpatient stays (P=0.054 for trend) and 30 day mortality (P=0.091 for trend) were both unchanged. Averaged over the study period, 30 day rates of any hospital revisit were similar after discharge from index emergency department treatment-and-discharge stays (19.9%) and index observation stays (20.1%), as was 30 day mortality (1.8% for both). Rates of any hospital revisit (21.8%) and death (5.2%) were highest after discharge from index inpatient stays. Conclusions Hospital revisits are common after discharge from observation stays, frequently result in inpatient hospitalizations, and have increased over time among Medicare beneficiaries. As revisit rates are similar after emergency department and observation stays, strategies shown to enhance emergency department transitional care may be reasonable starting points to improve post-observation outcomes.

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Ensuring the Quality of Quality Metrics for Emergency Care

Adams

2016

JAMA

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Revisit Rates and Associated Costs After an Emergency Department Encounter

Abstract: Agency for Healthcare Research and Quality.

Cited by 112 publications

References 15 publications

Understanding Emergency Department 72-Hour Revisits Among Medicaid Patients Using Electronic Healthcare Records

Understanding Emergency Department 72-Hour Revisits Among Medicaid Patients Using Electronic Healthcare Records

Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study

Ensuring the Quality of Quality Metrics for Emergency Care

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