Reference no: EM133561959

Case Study: Hospital K is a 400-bed trauma level one academic medical center providing care to the community for more than 30 years. The level of ED visits has led administrators to investigate other mechanisms to ensure appropriate utilization of the ED. Hospital K has decided to open up an express care clinic to provide patients the mechanism of receiving care expeditiously.

PB, a 73-year-old patient, has recently been admitted due to fainting at home. PB admits to avoiding the ED because of fear of contracting COVID-19 during the global pandemic. Upon arrival, Dr. RJ assesses PB's neurological, urinary, and endocrine systems. PB reports taking water pills without appropriate follow-up care and experiencing periods of confusion and abdomen pain. Dr. RJ plans to admit PB with a diagnosis of acute kidney failure.

APPROACH

COVID-19 led to patients becoming ill at home and not seeking medical help. A study by the CDC comparing March 31 to April 27, 2019, prior to the pandemic, to the similar 4-week period March 29 to April 25, 2020, during the early phase of the pandemic, found that U.S. ED visits were 42% lower in 2020, indicating that some people were delaying care for potentially serious conditions, including nonspecific chest pain and acute myocardial infarction (Hartnett et al., 2020Links to an external site.).

As COVID-19 numbers decline across the country, health systems saw the number of patients visiting the ED trend resume to pre-COVID numbers. An August 2021 survey by global management consulting firm McKinsey & Company reported that ED and inpatient volumes had returned to 2019 levels and projected that volumes would rise 5% to 6% higher in 2022 (Berlin et al., 2021Links to an external site.). Minority patients across the country tend to visit EDs versus going to see a PCP. Studies have found that the use of EDs is particularly high among Black and Hispanic patients and women, as well as Medicare and Medicaid beneficiaries (Hanchate et al., 2019Links to an external site.; Marcozzi et al., 2018Links to an external site.). The increase of ambulatory clinics has emerged as a result of patients needing access to reduce ED utilization.

Patient education regarding the mechanisms to access care is integral to improving SDOH. Because there are myriad socioeconomic and racial disparities that create barriers to healthcare access, vulnerable populations often turn to EDs for non-emergency care (Marcozzi et al., 2018Links to an external site.). Educational efforts focused on these vulnerable populations can help patients understand that there are other avenues to attain the care they need in a timely fashion, without having to resort to EDs. The American Academy of Family Physicians (AAFP) recommends a team-based approach to addressing the SDOH, urging physicians and medical practices to ask patients about their circumstances, identify resources within their communities to assist them, and act to connect patients with those resources, thereby helping to educate patients about their options (AAFP, 2018Links to an external site.).

The establishment of ambulatory clinics necessitates the need to educate patients about the mechanisms by which they can obtain care. A comprehensive marketing plan is necessary to ensure patients understand the new service and methods to begin receiving care.

INTERPRETATION

A March 2021 report to Congress by the Office of the Assistant Secretary for Planning and Evaluation, DHHS, found that there are many issues surrounding the perceived overuse or inappropriate use of EDs, including a lack of understanding on the part of patients about what constitutes an actual emergency, a lack of access or long wait times for PCPs or other alternative avenues for care, and a lack of insurance coverage and concerns about ability to pay (DHHS, 2021Links to an external site.). The same report pointed out that over-utilization of EDs creates many challenges for the U.S. healthcare system, including the significantly higher cost for emergency care as compared to ambulatory or other care settings, as well as other factors, such as overcrowding, long wait times, a lack of continuity of care, and a deficit in preventive care services, all of which can lead to higher patient mortality (DHHS, 2021Links to an external site.). It is therefore incumbent upon healthcare providers to study and understand the factors driving patient usage of EDs and develop plans to educate and inform those patients about care alternatives.

ACCESS TO CARE

The SDOH have major implications on patients' access to care and preventive screenings, which can be especially troubling when it comes to serious illnesses such as cardiovascular disease, respiratory disease, and cancer, where lack of preventive and follow-up care can lead to significantly higher mortality rates. Despite this fact, many healthcare organizations are not addressing SDOH in their patient assessment process. A 2021 study from researchers at New York-Presbyterian and Weill Cornell Medicine pointed out that only 15.6% of U.S. physician practices and 24.4% of U.S. hospital systems screen patients for multiple SDOH, including food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence; the study reported that the top barriers in access to care reported by cancer patients were economic instability, education and low health literacy, and community and social context, including bias, stigma, and cultural misconceptions (Jou et al., 2021Links to an external site.).

OUTCOME

Stakeholders should work to determine a business plan and communication plan. The business plan should include assessment of ED utilization and readmissions. The communication plan should focus on internal and external success.

QUESTIONS:

1. What activities and considerations would you include in communicating new primary care clinics at your organization to the community?

2. What factors should leadership take into account to determine whether express care clinics can be beneficial for their patient population?

3. What are some key elements to be used by the patient upon discharge?