The prehospital and hospital costs of emergency care for frequent ED patients

Solberg, Robert; Edwards, Brandy L.; Chidester, Jeffrey P.; Perina, Debra G.; Brady, William J.; Williams, Michael D.

doi:10.1016/j.ajem.2015.11.066

Cited by 20 publications

(19 citation statements)

References 33 publications

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“…Repeated utilization of a healthcare service by a small group of patients is costly 1,2 and also suggests that the medical care those patients are receiving is not adequately addressing their needs. 3,4 Frequent utilization of emergency department (ED) services have been extensively studied, 5–13 in part because ED care is more expensive than primary care and these two types of care may be substitutes for one another in some cases.…”

Section: Introductionmentioning

confidence: 99%

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Evans

Platts‐Mills

Fernández

et al. 2017

Annals of Emergency Medicine

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OBJECTIVE The objective of this study was to characterize repeat Emergency Medical Services (EMS) transports among older adults across a large and socioeconomically diverse region. METHODS Using the North Carolina Prehospital Medical Information System (PreMIS), we analyzed the frequency of repeat EMS transports within 30 days of an index EMS transport among adults aged 65 years and older from 2010–2015. We used multivariable logistic regressions to determine characteristics associated with repeat EMS transport. RESULTS Over the 6-year period, EMS performed 1,711,669 transports for 689,664 unique older adults in North Carolina. Of these, 303,099 (17.7%) transports were followed by another transport of the same patient within 30 days. The key characteristics associated with an increased adjusted odds ratio of repeat transport within 30 days include: transport from an institutionalized setting (OR 1.42, 95% Confidence Interval (CI) 1.38–1.47), Blacks compared to Whites (OR 1.29, 95% CI 1.24–1.33), a dispatch complaint of psychiatric problems (OR 1.38, 95% CI 1.25–1.52), back pain (OR 1.35, 95% CI 1.26–1.45), breathing problems (OR 1.21, 95% CI 1.15–1.30), and diabetic problems (OR 1.14, 95% CI 1.06–1.22). Falls accounted for 15.6% of all transports and had a modest association with repeat transports (OR 1.07, 95% CI 1.00–1.14). CONCLUSIONS More than 1 in 6 EMS transports of older adults in North Carolina are followed by a repeat transport of the same patient within 30 days. Patient characteristics and chief complaints may identify increased risk for repeat transport and suggest the potential for targeted interventions to improve outcomes and manage EMS utilization.

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Section: Introductionmentioning

confidence: 99%

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Evans

Platts‐Mills

Fernández

et al. 2017

Annals of Emergency Medicine

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“…In 2015, for example, total Medicare expenditure was $632 billion; approximately 25% of this cost was due to in-hospital care [4]. An additional 10% of the total cost was due to readmissions through emergency transports alone, which are common in older adults [5]. …”

Section: Introductionmentioning

confidence: 99%

Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data

Agboola

Golas

Fischer

et al. 2017

BMC Health Serv Res

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BackgroundPersonal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization.MethodsRetrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011–2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria.ResultsThe overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly (p = 0.16) over the study period, 90-days (p = 0.03) and 180-days (p = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only).ConclusionsChronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can provide useful insights that can be used to improve health outcomes in older patients.

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“…The decision whether or not a hospitalised patient is appropriate for discharge requires evaluation of multiple factors involving medical, as well as psychosocial, logistic, and economic considerations. Discharge planning should involve the clinical staff and patient/family caregivers to develop a patient‐centred plan: this process should include the evaluation of medical necessities and the evaluation of the environment that could provide care after discharge …”

Section: Introductionmentioning

confidence: 99%

“…However, bounce‐back patients require resources of an already strained set withdrawn from patients presenting for acute care. In an era characterised by the global ageing of the in‐hospital population and by a healthcare system worried with cost reduction, hospital readmission after discharge is an important clinical and health policy issue …”

Section: Introductionmentioning

confidence: 99%

“…Discharge planning should involve the clinical staff and patient/family caregivers to develop a patientcentred plan: this process should include the evaluation of medical necessities and the evaluation of the environment that could provide care after discharge. 15 In parallel with efforts to decrease the length of stay for hospitalised patients over the past two decades, a reasonable concern has been raised that early discharge, if premature, could increase adverse events after discharge and rates of readmission, both signs of poor quality hospital care and a further burden on an already stretched system. 15,16 Premature discharge and inadequate postdischarge support could increase "bounce-back" patients or the so-called "revolving door phenomenon" but there is not strong available evidence to suggest that earlier discharge is associated with readmission.…”

mentioning

confidence: 99%

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Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

et al. 2018

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Summary Background Reverse triage (RT) identifies patients eligible for discharge and have been proposed to cope with daily surge. Nevertheless, early discharge could increase the rate of readmission. Our aim is to test the effectiveness and safety of RT alone and with readmission screening tools (Identification Senior At Risk [ISAR], HOSPITAL, and Groeningen Frailty Index [GFI] scores) to predict appropriate discharge. Material and methods We prospectively assessed every 4 days (t0) inpatients of medical divisions (High Dependency Unit (HDU), Internal Medicine (IM), and Geriatrics (Ger)) of an Italian Hospital. RT score was calculated for each patient and an RT ≤3 identified those eligible for safe discharge. ISAR, HOSPITAL, and GFI were then applied. We assessed reinstituting of interventions and transferring to an increased level of care unit at 4 days as an ethical proxy of consequential medical events following hypothetical discharge. Date of effective discharge, death, and readmission were measured at 4, 7, 15, and 30 days after the first evaluation. Results Twenty‐five (9.6%) out of 260 patients in our sample had an RT ≤3. Twenty‐four (96%) of them compared with 205 (87%) of the RT >3 group (P = NS) were discharged. Patients with RT ≤3 were discharged significantly earlier (3.5 vs 8 days after t0 [P = 0.0002]). In the RT ≤3 group, all but one patient were alive and healthy at 7, 15, and 30 days. The HOSPITAL score seemed to have the best concordance with RT (84%), in comparison with the ISAR (52%) and the GFI (48%) scores. RT showed a low sensitivity (22%) and high specificity (95%), which was even higher when using RT associated with readmission screening tools. Conclusions Reverse triage proved to be a safe and conservative tool, with high specificity alone and with readmission screening tools. RT correctly identifies patients that will be discharged earlier.

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The prehospital and hospital costs of emergency care for frequent ED patients

Cited by 20 publications

References 33 publications

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data

Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

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