ED care management team alone won't reduce use, study finds
- Emergency department care management programs can help link patients to primary care, but won’t reduce subsequent acute care utilization without addressing social determinants of health, an article in NEJM Catalyst concluded.
- The researchers deployed care management teams at six of the busiest NYC Health + Hospitals EDs. Each team included a registered nurse, care managers, a community health worker, pharmacist, home care nurse and a physician liaison. A total of 94,339 patients enrolled in the program between Sept. 1, 2014, and Aug. 31, 2017 — about 10% of all patients who came through the EDs.
- Despite more face-to-face engagement, telephone follow-ups, medication management and other interventions, the study group’s hospitalization and ED revisit rates were no better than controls — between 4% and 5%.
Hospitals have a strong incentive to reduce ED overutilization and help patients stay healthy. Emergency room visits are more costly than routine care, and some are avoidable.
Many hospitals are using team-based methods to try and reduce ED use. One challenge, the researchers discerned, was the one-size-fits-all approach of the intervention model. Differences in patient populations, insurance coverage, physical layout and access to primary care doctors and community resources affected how the program functioned at each of the EDs.
“Our socioeconomically and culturally diverse population — including a disproportionate number of patients who are uninsured, transient or homeless, or simply sicker — require discharge plans unique to each patient,” the study said.
Moreover, while the care management teams often uncovered social needs such as unstable housing or poor access to transportation, resources and partnerships were not in place to deal with those needs, the researchers said. More providers and payers are trying methods to address such population health factors, but they face a number of complications.
"Challenges to ensure adequate community-based resources to meet patients’ social needs ... can limit the impact of transitional care services," the researchers concluded. "These social determinants of health needs may need to be addressed to successfully reduce avoidable ED visits."
They recommend targeting high-risk patients with “'higher-touch’ intensity” in future intervention efforts.