Community-Based Program Cut ED Visits by Nearly 30%

Alexandra Wilson Pecci, October 4, 2017

The program also reduced hospital admissions and increased the use of primary care doctors. 

A community-based program that helped high ED users get things like household resources, access to transportation, and help applying for assistance programs reduced ED visits and hospital admissions, finds new research.

It also increased the use of primary care doctors, according to the study published in the journal Health Affairs.

"Many programs have tried to tackle the problem of high utilizers of hospital emergency departments. These are usually people who are on Medicaid," the study's first author Roberta Capp, MD, an assistant professor of emergency medicine at the University of Colorado School of Medicine, said in a statement. "But this is the first program to show that care coordination actually works."

Capp and her team used and evaluated Bridges to Care (B2C), an ED-initiated, community-based program. It was one of four sites funded by a CMS Innovations grant. The program was led by Rutgers University Center for State Health Policy and developed in collaboration with four Colorado stakeholders including an urban academic hospital, a network of 13 local federally qualified health centers, a mental health clinic and a community advocacy organization.

The B2C program targeted Medicaid-eligible high ED users, defined as adults who had two or more ED visits or hospital admissions within the last 180 days.

These patients got a personally tailored, 60-day care plan that included housing help, refugee services, and access to transportation. They also got help applying for insurance and disability benefits, setting up medical appointments, and filling prescriptions, among other services.

During the six months after B2C enrollment, the participants had:

·         29.7% fewer ED visits

·         30% less hospitalizations

·         123% more primary care visits than the control subjects

"There is a perspective from multiple stakeholders that high users of the ED are difficult patients," Capp said. "But this study shows that patients use the ED because of there are serious barriers to care.”

Those barriers can include multiple chronic diseases, including mental illness, the authors said.

Although care coordination has been shown to reduce costs, other programs aimed at reducing ED usage have been only hospital based and have had mixed results, the researchers said.

The difference with the B2C intervention is that it combines active ED outreach with multidisciplinary, community-based services, including a care coordinator, a health coach, a behavioral health specialist, a community health worker, and frequent home visits.

"We believe that our success stems from bringing together different healthcare systems, breaking down silos between disciplines and focusing on continuity of care in the outpatient setting," Capp said.

"We learned that active outreach in the ED is key to ensuring successful high utilizer and enrollment and engagement," the study said.

Alexandra Wilson Pecci

Alexandra Wilson Pecci is an editor for HealthLeaders Media.

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