The Relationship between Same-Day Access and Continuity in Primary Care and Emergency Department Visits

Yoon, Jean; Cordasco, Kristina M.; Chow, Andrea W.; Rubenstein, Lisa V.

doi:10.1371/journal.pone.0135274

Cited by 25 publications

(19 citation statements)

References 25 publications

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“…Engagement and care coordination through Assertive Community Treatment (ACT) teams has resulted in improved health outcomes and decreased use of acute services in severely mentally ill homeless populations (39). Also, same-day primary care in the VA system has been associated with decreased use of EDs for problems that can be managed as an outpatient and might not necessarily require acute services (40). Perhaps most striking is the growing number of studies that have found decreased use of acute services after entry in to supportive housing with case management (41–43).…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Emergency Department Use by a Chronically Homeless Population

Moore¹,

Rosenheck²

2016

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Objective Homeless adults make extensive use of emergency department (ED) services. This study examined factors associated with moderate and high ED use in a cohort of chronically homeless individuals. Methods A cross-sectional analysis identified factors related to ED use in a cohort of 755 individuals at 11 sites at entry into in the Collaborative Initiative to Help End Chronic Homelessness (CICH). Bivariate analyses identified sociodemographic, housing status, health status, and service-related factors associated with moderate and high ED use. Independent risk factors were then identified using a multivariate multinomial model. Hierarchical regression was used to compare the strengths of association between ED use and blocks of factors composed of sociodemographic, housing, health, and service-related characteristics. Results In a 3-month period, 30% of participants visited the ED 1 or 2 times (moderate ED use) and 12% used the ED 3 or more times (high-ED use). ED use was most strongly associated with poor health status and utilization of other non-ED services, and to a lesser extent with housing status. Conclusions Increased ED utilization was associated with both medical and psychiatric morbidity and greater use of non-ED services. ED use is thus related to high need and acuity and is not ameliorated by use of other services. Housing instability and homelessness contribute less robustly to increased ED use. More coordinated services may better address the complex medical, housing, and psychosocial needs of chronically homeless individuals.

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Emergency Department Use by a Chronically Homeless Population

Moore¹,

Rosenheck²

2016

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“…It is assumed that if primary care is made more accessible and available, patients will visit EDs less frequently, but existing literature provides mixed evidence to support such a rationale . Some evidence suggests that having a regular source of PHC and continuity of care can significantly reduce the likelihood of inappropriate use of the ED and that frequent ED visitors are less likely to report that they get what they need from their PHC . Bolíbar et al found that in a city in Spain, users of health centres that had been the target of organizational reform attended less the ED than those who had not been the target of intervention, but ED use was inappropriate regardless of the PHC model.…”

Section: Introductionmentioning

confidence: 99%

The impact of primary health care reform on hospital emergency department overcrowding: Evidence from the Portuguese reform

Almeida

Vales

2019

Health Planning & Management

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Context: The reduction in inappropriate utilization of hospitals' emergency departments (EDs) is usually an important objective of primary health care (PHC) reforms. Existing literature provides mixed evidence on the effectiveness of PHC reforms in reducing inappropriate utilization of ED. We assess whether the specific PHC reforms ongoing in Portugal since 2005, and in particular the creation of family health units (FHUs), were successful in reducing inappropriate utilization of EDs and provide a contribution to the debate of which PHC models contribute to reduce overuse of EDs. Methods: We use patient-level data of 117 391 ED visits from two nonurban hospitals in Portugal to estimate a multivariate logistic regression that assesses the impact of different PHC models on inappropriate ED visits. Patients in our sample had four different models of PHC provision: the new FHU type A or type B and the old personalized health care units (PHUs), with or without a specific family physician assigned. Results:The percentage of episodes that correspond to appropriate visits to the ED is 2% higher for patients enrolled in an FHU type B and 0.8% higher for users of FHU type A, when compared with users enrolled in PHU. Having an assigned family physician increases appropriate use of the ED by 1%. Conclusion:Portugal's PHC reform was successful in reducing inappropriate utilization of EDs.

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“…Other investigators have explored the relations between access and continuity of care, 16,25,38,39,45,[50][51][52][53][54][55][56][57][58][59][60] access and emergency department use, 16,[61][62][63][64][65][66][67][68][69][70][71][72] and continuity of care and emergency department use. 4,[12][13][14][15]63,73,74 Various algorithms have been used to develop virtual panels to associate patient to activity to specific physicians.…”

Section: Discussionmentioning

confidence: 99%