- Use of health information exchanges could provide a solution to avoiding unnecessary visits to emergency departments while improving patient care, according to a recent study in the Southern Medical Journal.
A team of researchers used data from a regional health information exchange in the greater Charleston area to identify characteristics of frequent emergency department users, which could lead to target interventions aimed at directing patients to appropriate, non-emergency care settings.
"There are many opportunities to use HIE as a tool by which to improve healthcare delivery for FEDUs," wrote Saef et al. "Once identified, strategic targeting of limited resources can be directed to FEDUs to improve the coordination of their health care. Healthcare navigators could be assigned to FEDUs with the goal of identifying deficiencies that resulted in their use of the ED instead of a primary care clinic for ambulatory care–sensitive conditions, improving health care, and reducing costs."
As the team of researchers noted, in certain parts of the country nearly one-third (28%) of the 136 million ED visits annually in the United States can be attributed to frequent emergency department users. While the use of health information exchange by emergency physicians could help eliminate or reduce duplicate testing, its secondary benefit could come in the form of addressing the causes behind patients presenting in emergency rooms in the first place.
"The ED is not poised to offer the benefits of primary care as espoused by the Framingham Heart Study and a large Department of Veterans Affairs cooperative study," they explained. "Transfer to a medical home designed to provide longitudinal care could improve patients' health by addressing cardiovascular risk factors and screening for cancer."
Data pulled from the regional HIE between 2012 and 2013 of adult patients with information in the health information network revealed the following comparatives:
Patients aged 35 to 44 years were 16% more likely to be FEDUs than those aged 65 years and older (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.02–1.32). African Americans were 9% more likely than whites to be FEDUs (OR 1.09, 95% CI 1.03–1.25). Dualpay (Medicaid and Medicare) patients were almost three times more likely than those with commercial insurance to be FEDUs (OR 2.81, 95% CI 2.47–3.21). Patients with Medicare were 77% more likely (OR 1.77, 95% CI 1.57–1.99) and those with Medicaid were 71% more likely (OR 1.71, 95% CI 1.57–1.86) than those with commercial insurance to be FEDUs.
According to the researchers, their findings countered suspicions of higher emergency department use by certain patient populations. Instead, insurance coverage proved to be a key factor.
"Although it is commonly suspected that uninsured minorities make up the bulk of the patients who frequently use the ED, analysis of our data showed that this was not the case; in fact, the greatest predictor, outside of specific medical complaints, of a patient being a FEDU was having a dual Medicare and Medicaid payer classification," said Saef et al.
Digging deeper, the study's findings point to factors leading non-emergency patients into the ED. One has to do with the immediacy of care access. Patients with "ill-defined conditions" — general and non-specific health issues — were often seeking a physician assessment or medication (e.g., narcotics) and unable to wait for an appointment.
Researchers explained that a lack of convenient access to care was the impetus behind 35-44 year-old patients as a result of "their desire for convenient care that fits around work schedules and other obligations."
Conversely, a close proximity to emergency services also played a part in greater urban and suburban ED use. " . It seems obvious that the less of a barrier there is to accessing the ED, the greater would be the willingness of patients to seek care there. When an ED is closer and easier to access, patients may be more likely to visit for less emergent reasons," the authors maintained.
Another factor was patient knowledge of where to find appropriate medical care for mental and behavioral health conditions.
" any patients with mental disorders lack the skills to navigate the healthcare system and frequently do not have regular healthcare providers," wrote Saef et al. "These patients often are unable to obtain their medications, have difficulties with transportation, and have difficulty keeping doctor's appointments. Poor coping skills may lead these patients to use the ED even for minor health issues."
While provider HIE use can help ED physicians better serve patients in their care, its use upstream to identify at-risk patient populations and coordinate care could ensure that that care takes place in the most appropriate setting.