Emergency department visit frequency and health care costs following implementation of an integrated practice unit for frequent utilizers.

IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Academic Emergency Medicine Pub Date : 2024-11-01 Epub Date: 2024-06-26 DOI:10.1111/acem.14973
Ruixuan Wang, Kiran Lukose, Olga S Ensz, Lee Revere, Noah Hammarlund
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Abstract

Objectives: The integrated practice unit (IPU) aims to improve care for patients with complex medical and social needs through care coordination, medication reconciliation, and connection to community resources. This study examined the effects of IPU enrollment on emergency department (ED) utilization and health care costs among frequent ED utilizers with complex needs.

Methods: We extracted electronic health records (EHR) data from patients in a large health care system who had at least four distinct ED visits within any 6-month period between March 1, 2018, and May 30, 2021. Interrupted time series (ITS) analyses were performed to evaluate the impact of IPU enrollment on monthly ED visits and health care costs. A control group was matched to IPU patients using a propensity score at a 3:1 ratio.

Results: We analyzed EHRs of 775 IPU patients with a control group of 2325 patients (mean [±SD] age 43.6 [±17]; 45.8% female; 50.9% White, 42.3% Black). In the single ITS analysis, IPU enrollment was associated with a decrease of 0.24 ED visits (p < 0.001) and a cost reduction of $466.37 (p = 0.040) in the first month, followed by decreases of 0.11 ED visits (p < 0.001) and $417.61 in costs (p < 0.001) each month over the subsequent year. Our main results showed that, compared to the matched control group, IPU patients experienced 0.20 more ED visits (p < 0.001) after their fourth ED visit within 6 months, offset by a reduction of 0.02 visits (p < 0.001) each month over the next year. No significant immediate or sustained increase in costs was observed for IPU-enrolled patients compared to the control group.

Conclusions: This quasi-experimental study of frequent ED utilizers demonstrated an initial increase in ED visits following IPU enrollment, followed by a reduction in ED utilization over subsequent 12 months without increasing costs, supporting IPU's effectiveness in managing patients with complex needs and limited access to care.

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为经常使用急诊室的患者实施综合实践单元后的急诊室就诊频率和医疗费用。
目标:综合实践病房(IPU)旨在通过护理协调、药物调节以及与社区资源的联系,改善对具有复杂医疗和社会需求的患者的护理。本研究探讨了 IPU 的加入对急诊科(ED)使用率和医疗费用的影响:我们从一个大型医疗保健系统中提取了患者的电子健康记录(EHR)数据,这些患者在 2018 年 3 月 1 日至 2021 年 5 月 30 日之间的任何 6 个月内至少有四次不同的急诊就诊经历。我们进行了间断时间序列 (ITS) 分析,以评估 IPU 注册对每月急诊室就诊次数和医疗费用的影响。对照组与 IPU 患者按 3:1 的比例进行倾向评分匹配:我们分析了 775 名 IPU 患者和 2325 名对照组患者(平均 [±SD] 年龄为 43.6 [±17] 岁;45.8% 为女性;50.9% 为白人,42.3% 为黑人)的电子病历。在单一 ITS 分析中,IPU 的加入与急诊室就诊次数减少 0.24 次相关(P 结论:IPU 的加入与急诊室就诊次数减少 0.24 次相关):这项针对经常使用急诊室的患者进行的准实验研究表明,在加入 IPU 后,急诊室就诊人次在初期有所增加,但在随后的 12 个月内急诊室就诊人次有所减少,而费用却没有增加,这证明 IPU 在管理需求复杂且就医途径有限的患者方面非常有效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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