The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured

DeHaven, Mark J.; Kitzman-Ulrich, Heather; Gimpel, Nora; Culica, Dan; O'Neil, Leanne; Marcee, Alice K.; Foster, Barbara; Biggs, Melanie M.; Walton, James W.

doi:10.1093/pubmed/fds027

Cited by 26 publications

(71 citation statements)

References 24 publications

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“…However, the strength and even the direction of the relation seems to be highly dependent on other patient characteristics [11-13]. In this context, the availability of services and distance between the patient’s home and both types of services is suggested as a confounding factor [13].…”

Section: Discussionmentioning

confidence: 99%

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The impact of neighborhood deprivation on patients’ unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study

et al. 2013

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BackgroundThe use of unscheduled out of hours medical care is related to the social status of the patient. However, the social variance in the patient’s preference for a hospital based versus a primary care based facility, and the impact of specific patient characteristics such as the travel distance to both types of facilities is unclear. This study aims to determine the social gradient in emergency care seeking behavior (consulting the emergency department (ED) in a hospital or the community-based Primary Care Center (PCC)) taking into account patient characteristics including the geographical distance from the patient’s home to both services.MethodsA cross-sectional study, including 7,723 patients seeking out-of-hours care during 16 weekends and 2 public holidays was set up in all EDs and PCCs in Ghent, Belgium. Information on the consulted type of service, and neighborhood deprivation level was collected, but also the exact geographical distance from the patient’s home to both types of services, and if the patient has a regular GP.ResultsPatients living in a socially deprived area have a higher propensity to choose a hospital-based ED than their counterparts living in more affluent neighborhoods. This social difference persists when taking into account distance to both services, having a regular GP, and being hospitalized or not. The impact of the distance between the patient’s home address and the location of both types of services on the patient’s choice of service is rather small.ConclusionsInitiatives aiming to lead patients more to PCC by penalizing inappropriate ED use might increase health inequity when they are not twinned with interventions improving the access to primary care services and tackling the underlying mechanisms of patients’ emergency care seeking behavior. Further research exploring the impact of out-of-hours care organization (gatekeeping, payment systems, …) and the patient’s perspectives on out-of-hours care services is needed.

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Section: Discussionmentioning

confidence: 99%

“…However, a limited number of studies report a higher preference for PC services [11]. These different findings are considered as reflecting differences in local context variables.…”

Section: Introductionmentioning

confidence: 99%

The impact of neighborhood deprivation on patients’ unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study

et al. 2013

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“…Community health science is an alternative but complementary approach to the more traditional approach used by biomedical researchers . Traditional biomedical research has several limitations when it comes to preventing chronic diseases—it does not address the underlying social causes of disease, is rarely used in the community setting, and does not generally address the health problems of greatest concern to the community.…”

Section: Addressing Persistent Chronic Disease Prevalence Through Commentioning

confidence: 99%

“…15 Community health science is an alternative but complementary approach to the more traditional approach used by biomedical researchers. 16,17 Traditional biomedical research has several limitations when it comes to preventing chronic diseases-it does not address the underlying social causes of disease, is rarely used in the community setting, and does not generally address the health problems of greatest concern to the community. In contrast, community health science is more concerned with understanding the social determinants of health than the pathology of specific diseases, is more concerned clinically with health promotion and disease prevention than diagnosing and treating disease, and uses community-based participatory research (CBPR) approaches rather than clinic-based trials.…”

Section: Rethinking Health and Health Carementioning

confidence: 99%

Multimorbidity, chronic disease, and community health science

DeHaven

2016

Evaluation Clinical Practice

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“…This speaks to the need for a standardized definition of frequent users and methodologies to discriminate patient groups where interventions would be beneficial. There is a growing body of literature assessing the effectiveness of various interventions aimed at high users of the ED, including case management, individual care plans, and information sharing . These have shown mixed results, with the majority reporting minimal changes in ED utilization postintervention.…”

Section: Discussionmentioning

confidence: 99%

Variations in Resource Intensity and Cost Among High Users of the Emergency Department

et al. 2016

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Objectives: High users of emergency department (ED) services are often identified by number of visits per year, with little exploration of the distribution/pattern of visits over time. The purpose of this study was to examine patient-and encounter-level factors and costs related to periods of short-term resource intensity among high users of the ED within a tertiary care teaching facility. Methods:We identified all adults with at least three visits to the Ottawa Hospital ED within a 1-year period from April 1, 2012, to March 31, 2013. Within this high-user cohort, we then measured intensity of use by calculating average daily visit rates to identify individuals with a cluster of ED visits. Those with at least three ED visits/7 days at any point during follow-up were considered patients with clustered ED use (i.e., a period of short-term resource intensity). Detailed clinical and administrative data were used to compare patient-and encounter-level characteristics and cost profiles between the clustered and nonclustered groups. Analyses were repeated using varying cut points to define high users (at least five and at least eight visits per year).Results: Of the 16,153 patients identified as high ED users during the study period, 13.5% had their visits clustered within a short period of time. These clustered users were more likely to be homeless, to require psychiatric services, and to leave without being seen by a physician and less likely to be admitted to the hospital. Approximately one in three (31.2%) high ED users with clustered visits returned for the same medical problem (namely pain-related disorders, shortness of breath, and cellulitis) within a 1-week period. Similar trends were observed when the high-user cohort was restricted to those with at least five and at least eight ED visits/year. Finally, patients with short-term intensity periods had lower direct and indirect costs per encounter than those without.Conclusions: Using a novel methodology that accounts for both number and intensity of ED encounters over time, we were able to identify specific subpopulations of high ED users. Further work is required to determine if this methodology has utility for targeting care pathways within this heterogeneous and highrisk patient group.ACADEMIC EMERGENCY MEDICINE 2016;23:722-730

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The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured

Abstract: A broad-based community partnership program can significantly reduce ED utilization and related costs among the uninsured.

Cited by 26 publications

References 24 publications

The impact of neighborhood deprivation on patients’ unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study

The impact of neighborhood deprivation on patients’ unscheduled out-of-hours healthcare seeking behavior: a cross-sectional study

Multimorbidity, chronic disease, and community health science

Variations in Resource Intensity and Cost Among High Users of the Emergency Department

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