1
|
Dmitriew C, Houle DJ, Filipovic M, Chochla E, Hemy A, Woods C, Farhat N, Campbell A, Liu LJW, Cragg JJ, Crispo JAG. Transitional care clinics for patients discharged from hospital without a primary care provider: A systematic review. J Hosp Med 2024; 19:720-727. [PMID: 38623808 DOI: 10.1002/jhm.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The transition from hospital to home is a high-risk period. Timely follow-up care is essential to reducing avoidable harms such as adverse drug events, yet may be unattainable for patients who lack attachment to a primary care provider. Transitional care clinics (TCCs) have been proposed as a measure to improve health outcomes for patients discharged from hospital without an established provider. In this systematic review, we compared outcomes for unattached patients seen in TCCs after hospital discharge relative to care as usual. METHODS We searched the following bibliographic databases for articles published on or before August 12, 2022: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, PsycINFO, and Web of Science. Five studies were identified that examined the effects of a dedicated postdischarge clinic on emergency department (ED) visits, readmissions, and/or mortality within 90 days of discharge for patients with no attachment to a primary care provider. RESULTS Studies were heterogeneous in design and quality; all were from urban centers within the United States. Four of the five studies reported a reduction in either the number of ED visits or readmissions in patients seen in a TCC following hospitalization. CONCLUSIONS TCCs may be effective in reducing hospital contacts in the period following hospital discharge in patients with no established primary care provider. Further studies are required to evaluate the health benefits attributable to the implementation of TCCs across a broad range of practice contexts, as well as the cost implications of this model.
Collapse
Affiliation(s)
- Cait Dmitriew
- Department of Family Medicine, NOSM University, Sudbury, Ontario, Canada
| | - Del J Houle
- Undergraduate Medical Education Program, NOSM University, Sudbury, Ontario, Canada
| | - Michelle Filipovic
- Department of Family Medicine, NOSM University, Sault Ste. Marie, Ontario, Canada
| | - Ella Chochla
- Department of Family Medicine, NOSM University, Sault Ste. Marie, Ontario, Canada
| | - Alexander Hemy
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Celeste Woods
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nawal Farhat
- School of Mathematics and Statistics, Carleton University, Ottawa, Ontario, Canada
- TruEffect Inc., Sudbury, Ontario, Canada
| | - Alanna Campbell
- Health Sciences Library, NOSM University, Sudbury, Ontario, Canada
- Human Sciences Division, NOSM University, Sudbury, Ontario, Canada
| | - Lisa J W Liu
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacquelyn J Cragg
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - James A G Crispo
- TruEffect Inc., Sudbury, Ontario, Canada
- Human Sciences Division, NOSM University, Sudbury, Ontario, Canada
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
2
|
Kaur H, Yuki I, Shimizu T, Paganini-Hill A, Xu J, Golshani K, Hsu FPK, Nguyen T, Jin CM, Suzuki S. Follow-up care compliance among patients diagnosed with unruptured intracranial aneurysms. J Stroke Cerebrovasc Dis 2024; 33:107786. [PMID: 38782166 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Periodic imaging follow-up for patients with unruptured intracranial aneurysms (UIA) is crucial, as studies indicate higher rupture risk with aneurysm growth. However, few studies address patient adherence to follow-up recommendations. This study aims to identify compliance rates and factors influencing follow-up adherence. METHODS Patients with a UIA were identified from our institution's database from 2011-2021. Follow-up imaging (CT/MR Angiogram) was advised at specific intervals. Patients were categorized into compliant and non-compliant groups based on first-year compliance. Factors contributing to compliance were assessed through multivariate logistic regression. Phone interviews were conducted with non-compliant patients to understand reasons for non-adherence. RESULTS Among 923 UIA diagnosed patients, 337 were randomly selected for analysis. The median follow-up period was 1.4 years, with a 42% first-year compliance rate. The mean aneurysm size was 3.3 mm. Five patients had a rupture during follow-up, of which 4 died. Compared with patients consulting specialists at the initial diagnosis, those seen by non-specialists exhibited lower compliance (OR 0.25, p < 0.001). Loss to follow-up was greatest during transition from emergency service to specialist appointments. Patients who spoke languages other than English exhibited poorer compliance than those speaking English (OR 0.20, p = 0.01). CONCLUSIONS Significant amounts of UIA patients at low rupture risk were lost to follow-up before seeing UIA specialists. Main non-compliance factors include inadequate comprehension of follow-up instructions, poor care transfer from non-specialists to specialist, and insurance barriers.
Collapse
Affiliation(s)
- Hemdeep Kaur
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Ichiro Yuki
- Department of Neurosurgery, University of California, Irvine, CA, United States.
| | - Timothy Shimizu
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | | | - Jordan Xu
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Kiarash Golshani
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Frank P K Hsu
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Tracy Nguyen
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Chloe M Jin
- Department of Neurosurgery, University of California, Irvine, CA, United States
| | - Shuichi Suzuki
- Department of Neurosurgery, University of California, Irvine, CA, United States
| |
Collapse
|
3
|
Li P, Kang T, Carrillo-Argueta S, Kassapidis V, Grohman R, Martinez MJ, Sartori DJ, Hayes R, Jervis R, Moussa M. Bridging the gap: a resident-led transitional care clinic to improve post hospital care in a safety-net academic community hospital. BMJ Open Qual 2024; 13:e002289. [PMID: 38508663 PMCID: PMC10953301 DOI: 10.1136/bmjoq-2023-002289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/11/2024] [Indexed: 03/22/2024] Open
Abstract
The transitional period between hospital discharge and primary care follow-up is a vulnerable time for patients that can result in adverse health outcomes and preventable hospital readmissions. This is especially true for patients of safety-net hospitals (SNHs) who often struggle to secure primary care access when leaving the hospital due to social, economic and cultural barriers. In this study, we describe a resident-led postdischarge clinic that serves patients discharged from NYU Langone Hospital-Brooklyn, an urban safety-net academic hospital. In our multivariable analysis, there was no statistical difference in the readmission rate between those who completed the transitional care management and those who did not (OR 1.32 (0.75-2.36), p=0.336), but there was a statistically significant increase in primary care provider (PCP) engagement (OR 0.53 (0.45-0.62), p<0.001). Overall, this study describes a postdischarge clinic model embedded in a resident clinic in an urban SNH that is associated with increased PCP engagement, but no reduction in 30-day hospital readmissions.
Collapse
Affiliation(s)
- Patrick Li
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Tiffany Kang
- NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | | | - Vickie Kassapidis
- Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Rebecca Grohman
- Allergy and Immunology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Daniel J Sartori
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Rachael Hayes
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
- The Family Health Centers at NYU Langone, Brooklyn, NY, USA
| | - Ramiro Jervis
- Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Marwa Moussa
- Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra University, Staten Island, NY, USA
| |
Collapse
|
4
|
Hovey SW, Cho HJ, Kain C, Sauer HE, Smith CJ, Thomas CA. Pharmacist-Led Discharge Transitions of Care Interventions for Pediatric Patients: A Narrative Review. J Pediatr Pharmacol Ther 2023; 28:180-191. [PMID: 37303760 PMCID: PMC10249976 DOI: 10.5863/1551-6776-28.3.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/28/2022] [Indexed: 06/13/2023]
Abstract
Transitions of care (TOC) before, during, and after hospital discharge are an opportune setting to optimize medication management. The quality standards for pediatric care transitions, however, are lacking, leading to reduced health outcomes in children. This narrative review characterizes the pediatric populations that would benefit from focused, TOC interventions. Different types of medication-focused TOC interventions during hospital discharge are described, including medication reconciliation, education, access, and adherence tools. Various TOC intervention delivery models following hospital discharge are also reviewed. The goal of this narrative review is to help pediatric pharmacists and pharmacy leaders better understand TOC interventions and integrate them into the hospital discharge process for children and their caregivers.
Collapse
Affiliation(s)
- Sara W. Hovey
- Department of Pharmacy Practice (SWH), University of Illinois at Chicago, College of Pharmacy, Chicago, IL
| | - Hae Jin Cho
- Department of Pharmacotherapy (HJC), College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX
| | - Courtney Kain
- Department of Pharmacy (CK), Nemours Children's Hospital, Wilmington, DE
| | - Hannah E. Sauer
- Department of Pharmacy (HES), Texas Children's Hospital, Houston, TX
| | - Christina J. Smith
- Department of Pharmacy (CJS), Loma Linda University Children's Hospital, Loma Linda, CA
| | | |
Collapse
|
5
|
Zhang A, Spiegel T, Bundy A, Sullivan K, Green G, Chia S, Krishnamurthy R, Press VG. Evaluation of a transitions clinic to bridge emergency department and primary care. J Hosp Med 2023; 18:217-223. [PMID: 36737107 DOI: 10.1002/jhm.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/15/2022] [Accepted: 01/01/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Suboptimal transitions from the emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary nonurgent ED utilization. Care transition clinics (CTCs) are a potential solution by providing ED follow-up and facilitating the bridge to longer-term primary care. OBJECTIVE The objective was to evaluate the implementation of an ED transitions clinic on 30-day ED revisits and hospital readmissions. DESIGNS Retrospective cross-sectional study. SETTINGS AND PARTICIPANTS This study included adults 18 years and older discharged from the ED and reeferred to the CTC. MAIN OUTCOME AND MEASURES Appointment attendance, follow-up time, and frequencies of care type provided were computed to assess clinic utilization. Rates of 30-day ED revisit and hospital admission were compared between completed and missed appointments using logistic regression. RESULTS Between March 2021 and March 2022, 373 patients were referred to the CTC totaling 405 appointments. Half (53%) of appointments were completed with a median follow-up time of 4 days (IQR = [2, 7]). The most common care types provided were wound care (44%) and clinical problem management (33%), with wound care appointments more likely to be completed compared with clinical appointments (OR = 1.7, CI = [1.1, 2.8], p = .03). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment (OR = 0.51, CI = [0.27, 0.98], p < .05). No effect was seen for CTC appointment completion on hospital readmission. Transition clinics are a viable method to provide timely access to follow-up for patients discharged from the ED and may help reduce excess ED use for ambulatory care needs.
Collapse
Affiliation(s)
- Amanda Zhang
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Thomas Spiegel
- Department of Emergency Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Andrea Bundy
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kate Sullivan
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Geneatra Green
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | - Stephanie Chia
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Valerie G Press
- Center for Care Transformation, University of Chicago Medicine, Chicago, Illinois, USA
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| |
Collapse
|
6
|
Whiteside LK, D'Onofrio G, Fiellin DA, Edelman EJ, Richardson L, O'Connor P, Rothman RE, Cowan E, Lyons MS, Fockele CE, Saheed M, Freiermuth C, Punches BE, Guo C, Martel S, Owens PH, Coupet E, Hawk KF. Models for Implementing Emergency Department-Initiated Buprenorphine With Referral for Ongoing Medication Treatment at Emergency Department Discharge in Diverse Academic Centers. Ann Emerg Med 2022; 80:410-419. [PMID: 35752520 PMCID: PMC9588652 DOI: 10.1016/j.annemergmed.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 12/24/2022]
Abstract
There has been a substantial rise in the number of publications and training opportunities on the care and treatment of emergency department (ED) patients with opioid use disorder over the past several years. The American College of Emergency Physicians recently published recommendations for providing buprenorphine to patients with opioid use disorder, but barriers to implementing this clinical practice remain. We describe the models for implementing ED-initiated buprenorphine at 4 diverse urban, academic medical centers across the country as part of a federally funded effort termed "Project ED Health." These 4 sites successfully implemented unique ED-initiated buprenorphine programs as part of a comparison of implementation facilitation to traditional educational dissemination on the uptake of ED-initiated buprenorphine. Each site describes the elements central to the ED process, including screening, treatment initiation, referral, and follow-up, while harnessing organizational characteristics, including ED culture. Finally, we discuss common facilitators to program success, including information technology and electronic medical record integration, hospital-level support, strong connections with outpatient partners, and quality improvement processes.
Collapse
Affiliation(s)
- Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Gail D'Onofrio
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - David A Fiellin
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - E Jennifer Edelman
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Lynne Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick O'Connor
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ethan Cowan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael S Lyons
- Department of Emergency Medicine, Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Callan E Fockele
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
| | - Mustapha Saheed
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Caroline Freiermuth
- Department of Emergency Medicine, Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Brittany E Punches
- Department of Emergency Medicine, Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Clara Guo
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Shara Martel
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Patricia H Owens
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Edouard Coupet
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Kathryn F Hawk
- Department of Emergency Medicine, Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| |
Collapse
|
7
|
Thurstone C, Loh R, Piatz C, Simpson SA. Adolescent Substance Use Disorder Diagnosis Correlates With Hospitalization After an Emergency Department Visit. Pediatr Emerg Care 2022; 38:e1590-e1593. [PMID: 36066586 DOI: 10.1097/pec.0000000000002838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The purpose of this study is to compare the prevalence of hospitalization after an emergency department (ED) visit at an urban safety net hospital for youth with and without a substance use disorder. METHODS This study used a retrospective cohort design of adolescents (aged 15-21 y; n = 14,852) treated in the ED and compared the risk of hospitalization within 90 days. RESULTS A substance use disorder diagnosis in the ED more than doubled the risk of 90-day hospitalization (5.4% vs 2.38%; P < 0.0001). CONCLUSIONS Compared with youth without a substance use disorder, youth with substance use disorders are likely to require additional services after an ED visit.
Collapse
|
8
|
Development of a Primary Care Transitions Clinic in an Academic Medical Center. J Gen Intern Med 2022; 37:582-589. [PMID: 34327654 PMCID: PMC8321504 DOI: 10.1007/s11606-021-07019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/29/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Transitions of care experiences leave patients vulnerable to adverse outcomes, including readmissions, worsening symptoms, and reductions in functional status. AIM To describe and evaluate a primary care transitions clinic that serves patients with medical and/or social needs that must be addressed prior to establishment of primary care. SETTING Brigham Health, an academic medical center in Boston, MA. PROGRAM DESCRIPTION The transitions clinic opened within an existing primary care practice in January 2019. It employs one full-time nurse care coordinator and one full-time medical assistant, and is staffed by one primary care physician (PCP) or nurse practitioner each weekday afternoon. Both medical and social diagnoses that require follow-up post-discharge are addressed. Patients with any insurance are seen as many times as necessary until PCP care is established. PROGRAM EVALUATION In the year after its establishment (January 20, 2019, to January 19, 2020), the transitions clinic received 498 referrals (73.2% from the emergency department (ED), 23.3% from inpatient), with 207 patients ultimately seen. Patients were seen 5 (median; IQR 4-6) work days post-discharge, with 2 (median; IQR 1-3) visits per patient. Patients seen in the transitions clinic had significantly fewer ED visits than a comparator cohort referred to Brigham Health Primary Care after ED or hospital discharge in the year prior (January 20, 2018, to January 20, 2019). Patients seen in the transitions clinic additionally had significantly fewer ED visits and hospitalizations in the three months post-referral than in the three months pre-referral. The most common social determinants addressed by the clinic's nurse coordinator were insurance, transportation, and housing. DISCUSSION A primary care transitions clinic can provide accessible, attentive care post-discharge with positive effects on healthcare utilization. Availability of a multidisciplinary team that can see patients for repeated visits until establishment of PCP care was a key success factor for the transitions clinic.
Collapse
|
9
|
Santa Maria D, Lightfoot M, Nyamathi A, Businelle M, Paul M, Quadri Y, Padhye N, Jones J, Calvo Armijo M. A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial. JMIR Res Protoc 2021; 10:e26716. [PMID: 34018967 PMCID: PMC8178739 DOI: 10.2196/26716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID) DERR1-10.2196/26716
Collapse
Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies and UCSF Prevention Research Center, University of California San Francisco, San Francisco, CA, United States
| | - Adey Nyamathi
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Mary Paul
- Baylor College of Medicine, Houston, TX, United States
| | - Yasmeen Quadri
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Jones
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Margarita Calvo Armijo
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
10
|
Chen EM, Ahluwalia A, Parikh R, Nwanyanwu K. Ophthalmic Emergency Department Visits: Factors Associated With Loss to Follow-up. Am J Ophthalmol 2021; 222:126-136. [PMID: 32882220 PMCID: PMC8328190 DOI: 10.1016/j.ajo.2020.08.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe follow-up rates for patients referred for outpatient ophthalmic care after emergency department (ED) discharge and identify patient and visit characteristics associated with loss to follow-up (LTFU). DESIGN Single-institution retrospective cohort study. METHODS We analyzed the medical records of 2,206 patients seen in the ED for an eye-related issue who were subsequently scheduled for ophthalmology follow-up between 2013 and 2019 at a single tertiary health system. The main outcome measures were the frequency of and risk factors for LTFU and ED revisits. RESULTS In total, 1,649 (74.8%) patients completed follow-up within 2 months of an index ED visit. In multivariable analysis, younger age (P < .001), a nonurgent ophthalmic condition or nonophthalmic primary diagnosis (P < .001), scheduled follow-up >5 days after the ED visit (P < .001), additional follow-up appointments (<.001), no prior history of ophthalmology appointments (P = .045), a visual acuity of 20/40 or better (P = .027), and having Medicaid or being uninsured (P < .001) were significantly associated with LTFU. The presence of an interpreter significantly increased the likelihood of follow-up among non-English speaking patients (P < .001). LTFU was significantly associated with an ED revisit within 4 months of an index visit, and the ED revisit rate was significantly higher for patients LTFU vs those who completed follow-up (5.7% vs 1.1%; P < .001). CONCLUSIONS A quarter of patients referred for ophthalmic care after an ED presentation were LTFU. We identified numerous factors associated with LTFU that could be used to develop interventions to enhance follow-up. In addition, patients who were LTFU were more likely to revisit the ED for the same ophthalmic condition.
Collapse
Affiliation(s)
- Evan M Chen
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ravi Parikh
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Manhattan Retina and Eye Consultants, New York, New York, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA.
| |
Collapse
|
11
|
|
12
|
Identification of emergency department patients for referral to rapid-access addiction services. CAN J EMERG MED 2020; 22:170-177. [PMID: 32051043 DOI: 10.1017/cem.2019.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Substance-related emergency department (ED) visits are rapidly increasing. Despite this finding, many EDs do not have access to on-site addiction services. This study characterized substance-related ED presentations and assessed the ED health care team's perceived need for an on-site rapid-access addiction clinic for direct patient referral from the ED. METHODS This prospectively enrolled cohort study was conducted at an urban tertiary care ED from June to August 2018. Adult ED patients with problematic or high-risk substance use were enrolled by ED staff using a one-page form. The electronic and paper records from the index ED visit were reviewed. The primary outcome evaluated whether the ED health care team would have referred the patient to an on-site rapid-access addiction clinic, if one were available. RESULTS We received 557 enrolment forms and 458 were included in the analysis. Median age was 35 years, and 64% of included patients were male. Alcohol was the most commonly reported substance of problematic or high-risk use (60%). Previous ED visits within 7 days of the index visit were made by 28% of patients. The ED health care team indicated "Yes" for rapid-access addiction clinic referral from the ED for 66% of patients, with a mean of 4.3 patients referred per day during the study period. CONCLUSIONS At least four patients per day would have been referred to an on-site rapid-access addiction clinic from the ED, had one been available. This indicates a gap in care and collaborating with other sites that have successfully implemented this clinic model is an important next step.
Collapse
|
13
|
Klenk L, von Rütte C, Henssler JF, Sauter TC, Hautz WE, Exadaktylos AK, Müller M. Resource consumption of multi-substance users in the emergency room: A neglected patient group. PLoS One 2019; 14:e0223118. [PMID: 31557239 PMCID: PMC6763017 DOI: 10.1371/journal.pone.0223118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background Multi-substance use is accompanied by increased morbidity and mortality and responsible for a large number of emergency department (ED) consultations. To improve the treatment for this vulnerable group of patients, it is important to quantify and break down in detail the ED resources used during the ED treatment of multi-substance users. Methods This retrospective single centre case-control study included all ED consultations of multi-substance users over a three-year study period at a university hospital in Switzerland. Resource consumption of these patients was compared to an age-matched control group of non-multi-substance users. Results The analysis includes 867 ED consultations of multi-substance users compared to 4,335 age-matched controls (5:1). Multi-substance users needed more total resources (median tax points [medical currency] (IQR): 762 (459–1226) vs. 462 (196–833), p<0.001), especially physician, radiology, and laboratory resources. This difference persisted in multivariable analysis (geometric mean ratio (GMR) 1.2, 95% CI: 1.1–1.3, p = 0.001) adjusted for sociodemographic parameters, consultation characteristics, and patient comorbidity; the GMR was highest in ED laboratory and radiology resource consumption. Among multi-substance user, indirect and non-drug-related consultations had higher ED resource consumption compared to drug-related consultations. Furthermore, leading discipline as well as urgency were predictors of ED resource consumption. Moreover, multi-substance users had more revisits (55.2% vs. 24.9%, p<0.001) as well as longer ED and in-hospital stays (both: GMR 1.2, 95% CI: 1.1–1.3, p<0.001). Conclusion ED consultations of multi-substance users are expensive and resource intensive. Multi-substance users visited the ED more often and stayed longer at the ED and in-hospital. The findings of our study underline the importance of this patient group. Additional efforts should be made to improve their ED care. Special interventions should target this patient group in order to decrease the high frequency and costs of emergency consultations caused by multi-substance users.
Collapse
Affiliation(s)
- Laurence Klenk
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christina von Rütte
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan F. Henssler
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital Berlin, Charité University Medicine, Berlin, Germany
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Medical Skills Lab, Charité Medical School Berlin, Berlin, Germany
| | - Wolf E. Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
- * E-mail:
| |
Collapse
|
14
|
Luckenbaugh AN, Yan PL, Dauw CA, Ghani KR, Hollenbeck BK, Hollingsworth JM. Followup Care after Emergency Department Visits for Kidney Stones: A Missed Opportunity. UROLOGY PRACTICE 2018; 6:24-28. [PMID: 31032386 DOI: 10.1016/j.urpr.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction and Objective Follow-up care after an ED visit for kidney stones may help reduce ED revisits and increase use of stone prevention strategies. To test these hypotheses, we analyzed medical claims from working-age adults with kidney stones. Methods Using data from MarketScan (2003 to 2006), we first identified patients with an ED visit for kidney stones. We then determined which patients had an outpatient visit within 90 days of ED discharge. Finally, we used multivariable logistic regression to evaluate the association between receipt of follow-up care and ED revisit, as well as use of stone prevention strategies (24-hour urine testing and PPT prescription). Results Only 48.0% (n=33,741) of patients seen in the ED for kidney stones received follow-up care, 68.3% of which was with a urologist. While follow-up care was not associated with fewer ED revisits, patients who received it were more likely to undergo 24-hour urine testing (predicted probability, 2.2% vs. 0.9%; P<0.001) and be prescribed PPT (predicted probability, 10.6% vs. 8.9%; P<0.001), when compared to those who did not. Among patients who received follow-up care, use of stone prevention strategies was higher when the care was delivered by a urologist (predicted probability, 13.7% vs. 12.3%; P=0.001). Conclusions Over half of patients seen acutely in the ED for kidney stones do not receive follow-up care. Given that follow-up care is associated with greater use of stone prevention strategies, efforts to enhance linkages across healthcare settings are needed to provide patients with urinary stone disease higher quality care.
Collapse
Affiliation(s)
- Amy N Luckenbaugh
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School
| | - Phyllis L Yan
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School
| | - Casey A Dauw
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School
| | - Khurshid R Ghani
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School
| | - John M Hollingsworth
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School
| |
Collapse
|
15
|
Nogueira J, Abreu P, Guilherme P, Félix AC, Ferreira F, Nzwalo H, Marreiros A. Frequent Emergency Department Visits After Spontaneous Intracerebral Hemorrhage: Who Is at Risk? Neurohospitalist 2018; 8:166-170. [PMID: 30245765 DOI: 10.1177/1941874418755951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The long-term prognosis of spontaneous intracerebral hemorrhage (SICH) is poor. Frequent emergency department (ED) visits can signal increased risk of hospitalization and death. There are no studies describing the risk of frequent ED visits after SICH. Methods Retrospective cohort study of a community representative consecutive SICH survivors (2009-2015) from southern Portugal. Logistic regression analysis was performed to identify sociodemographic and clinical factors associated with frequent ED visits (≥4 visits) within the first year after hospital discharge. Results A total of 360 SICH survivors were identified, 358 (98.6%) of whom were followed. The median age was 72; 64% were males. The majority of survivors (n = 194, 54.2%) had at least 1 ED visit. Reasons for ED visits included infections, falls with trauma, and isolated neurological symptoms. Forty-four (12.3%) SICH survivors became frequent ED visitors. Frequent ED visitors were older and had more hospitalizations (P < .001) and ED visits (P < .001) prior to the SICH, unhealthy alcohol use (P = .049), longer period of index SICH hospitalization (P = .032), pneumonia during hospitalization (P = .001), and severe neurological impairment at discharge (P = .001). Pneumonia during index hospitalization (odds ratio [OR]: 3.08; confidence interval [CI]: 1.39-6.76; P = .005) and history of ED visits prior to SICH (OR: 1.64; CI: 1.19-2.26, P = .003) increased the likelihood of becoming a frequent ED visitor. Conclusions Predictors of frequent ED visits are identifiable at hospital discharge and during any ED visit. Improvement of transitional care and identification of at-risk patients may help reduce multiple ED visits.
Collapse
Affiliation(s)
- Jerina Nogueira
- Department of Biomedical Science and Medicine, Algarve University, Faro, Portugal
| | - Pedro Abreu
- Department of Biomedical Science and Medicine, Algarve University, Faro, Portugal
| | - Patrícia Guilherme
- Department of Neurology, Centro Hospitalar e Universitário do Algarve, Faro, Portugal
| | - Ana Catarina Félix
- Department of Neurology, Centro Hospitalar e Universitário do Algarve, Faro, Portugal
| | - Fátima Ferreira
- Department of Neurology, Centro Hospitalar e Universitário do Algarve, Faro, Portugal
| | - Hipólito Nzwalo
- Department of Biomedical Science and Medicine, Algarve University, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal
| | - Ana Marreiros
- Department of Biomedical Science and Medicine, Algarve University, Faro, Portugal.,Algarve Biomedical Center, Faro, Portugal
| |
Collapse
|
16
|
Gleason LJ, Escue ED, Hogan TM. Older Adult Emergency Department Pain Management Strategies. Clin Geriatr Med 2018; 34:491-504. [PMID: 30031429 DOI: 10.1016/j.cger.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Older adults frequently present to the emergency department (ED) with pain, which is often underrecognized and undertreated. There is high variability of pain management and prescribing practices by ED providers. This article focuses on treatment of older adults in the ED who present with pain and addresses special considerations for this population. Social supports and follow-up must be considered in discharge treatment recommendations.
Collapse
Affiliation(s)
- Lauren J Gleason
- Section of Geriatrics and Palliative Medicine, 5841 South Maryland Avenue, MC6098, Chicago, IL 60637, USA
| | - Emily D Escue
- Section of Geriatrics and Palliative Medicine, 5841 South Maryland Avenue, MC6098, Chicago, IL 60637, USA
| | - Teresita M Hogan
- Section of Geriatrics and Palliative Medicine, 5841 South Maryland Avenue, MC6098, Chicago, IL 60637, USA; Section of Emergency Medicine, L-550A (MC 5068), 5841 S, Maryland Avenue, Chicago, IL 60637, USA.
| |
Collapse
|
17
|
Peart A, Lewis V, Brown T, Russell G. Patient navigators facilitating access to primary care: a scoping review. BMJ Open 2018; 8:e019252. [PMID: 29550777 PMCID: PMC5875656 DOI: 10.1136/bmjopen-2017-019252] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/06/2018] [Accepted: 02/12/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Patient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred. SETTING AND PARTICIPANTS We used the Arksey and O'Malley scoping review method. Searches were conducted in MEDLINE, Embase, ProQuest Medical, other key databases and grey literature for studies reported in English from January 2000 to April 2016. We defined a patient navigator as a person or process creating a connection or link between a person needing primary care and a primary care provider. Our target population was people without a regular source of, affiliation or connection with primary care. Studies were included if they reported on participants who were connected to primary care by patient navigation and attended or made an appointment with a primary care provider. Data analysis involved descriptive numerical summaries and content analysis. RESULTS Twenty studies were included in the final scoping review. Most studies referred to 'patient navigator' or 'navigation' as the mechanism of connection to primary care. As such, we grouped the components according to Freeman's nine-principle framework of patient navigation. Seventeen studies included elements of patient-centred care: informed and involved patient, receptive and responsive health professionals and a coordinated, supportive healthcare environment. CONCLUSIONS Patient navigators may assist to connect people requiring primary care to appropriate providers and extend the concept of patient-centred care across different healthcare settings. Navigation requires further study to determine impact and cost-effectiveness and explore the experience of patients and their families.
Collapse
Affiliation(s)
- Annette Peart
- Southern Academic Primary Care Research Unit, Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Australia
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia
| | - Ted Brown
- Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Australia
| |
Collapse
|
18
|
Yoo SK, Bian SX, Lin E, Batth SS, Ng LW, Andrade J, Williams PA, Pham AH, Ragab OM, Schechter NR, Chang EL, Jennelle RLS. Development of a Radiation Oncology Resident Continuity Clinic to Improve Clinical Competency and Patient Compliance. Int J Radiat Oncol Biol Phys 2018; 100:551-555. [PMID: 29413269 DOI: 10.1016/j.ijrobp.2017.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 11/13/2017] [Accepted: 11/18/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Stella K Yoo
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California.
| | - Shelly X Bian
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Eugene Lin
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Palo Alto, California
| | - Sukhjeet S Batth
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Lydia W Ng
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Jacob Andrade
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Patrick A Williams
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Anthony H Pham
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Omar M Ragab
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Naomi R Schechter
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Richard L S Jennelle
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| |
Collapse
|
19
|
Chakravarthy V, Ryan MJ, Jaffer A, Golden R, McClenton R, Kim J, Press I, Johnson TJ. Efficacy of a Transition Clinic on Hospital Readmissions. Am J Med 2018; 131:178-184.e1. [PMID: 28941749 DOI: 10.1016/j.amjmed.2017.08.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A primary care-staffed transition clinic is one potential strategy for reducing 30-day re-admissions for patients without an established primary care physician, but the effectiveness has not been studied. The objective was to test whether patients who completed a postdischarge transition clinic appointment were less likely to be readmitted within 30 days. METHODS This retrospective cross-sectional study included adults with Medicare or Medicaid coverage who were discharged from general medicine units at Rush University Medical Center between October 2013 and October 2014. All patients had a follow-up appointment scheduled within 30 days of discharge in the transition clinic or with their primary care physician. A binary logistic regression model was constructed to test the relationship between 30-day readmission and follow-up appointment status, controlling for patient factors. RESULTS The sample included 1149 patients with scheduled follow-up appointments (24% in the transition clinic and 76% with their primary care physician). After controlling for patient demographic characteristics and clinical factors, patients who did not complete a scheduled transition clinic appointment had approximately 3 times higher odds of readmission compared with patients who completed a transition clinic appointment (adjusted odds ratio, 2.80; P = .004). There was no significant difference in the likelihood of 30-day readmission between patients completing a transition clinic appointment and those who were scheduled with their primary care physician. CONCLUSIONS A primary care-staffed transition clinic is a promising strategy for providing access after a recent hospitalization and effectively managing the initial posthospital discharge needs of vulnerable populations.
Collapse
Affiliation(s)
| | - Mary J Ryan
- Rush University Medical Center, Chicago, Ill
| | - Amir Jaffer
- Rush University Medical Center, Chicago, Ill
| | | | | | - Jisu Kim
- Rush University Medical Center, Chicago, Ill
| | - Irwin Press
- Rush University Medical Center, Chicago, Ill
| | | |
Collapse
|
20
|
Collaborative care from the emergency department for injured patients with prescription drug misuse: An open feasibility study. J Subst Abuse Treat 2017; 82:12-21. [PMID: 29021110 DOI: 10.1016/j.jsat.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 11/21/2022]
Abstract
Collaborative Care is a comprehensive longitudinal care management strategy. The purpose of this pilot effectiveness-implementation hybrid study was to determine the feasibility of a Collaborative Care intervention initiated from the Emergency Department and proceeding longitudinally for six months for injured patients with prescription drug misuse (PDM). Adult patients presenting to an urban ED with an injury were screened for eligibility from 2/2015-8/2015. Eligible participants with a positive screen for PDM were enrolled in the 'ED-LINC' intervention which included the following elements: 1) active care coordination and linkage, 2) medication safety and utilization of opioid guidelines 3) longitudinal care management and 4) utilization of Electronic Medical Record (EMR) innovations such as the statewide Emergency Department Information Exchange (EDIE) and statewide prescription monitoring program information for assessment and follow-up. Baseline characteristics of the sample were assessed and regression models were used to evaluate longitudinal trajectories of risk for PDM. A total of 36 participants (56% of patients approached) had PDM and 30 participants were enrolled. Of those enrolled, 37% had prescription stimulant misuse, 20% with prescription sedative misuse and 97% had prescription opioid misuse. Follow-up rates at all time points were ≥83%. Baseline levels of comorbidity were high; 57% endorsed recent heroin use and 70% endorsed symptoms consistent with major depression. Over 50% had five or more statewide ED visits and 53% had used three or more different ED's in the past year. On average, participants received a total of 85 minutes of ED-LINC over six months with 90% of participants receiving all four intervention elements. All patients had care coordinated with new or existing primary care providers (PCP's) and 23% were linked to a new PCP. A majority of patients (≥80%) reported receiving high quality, desired intervention services. There was no significant change in PDM over time. Collaborative Care initiated from the ED is feasible and acceptable to patients with trauma and PDM. Future directions could include effectiveness-implementation hybrid trials to study implementation barriers and strategies as well as patient-level outcomes of this intervention for this complex patient population.
Collapse
|
21
|
Carmel AS, Steel P, Tanouye R, Novikov A, Clark S, Sinha S, Tung J. Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions. West J Emerg Med 2017; 18:870-877. [PMID: 28874939 PMCID: PMC5576623 DOI: 10.5811/westjem.2017.5.33593] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/19/2017] [Accepted: 05/12/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. Methods We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates – WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. Results EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. Conclusion A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option that is also an effective mechanism for engaging patients in primary care.
Collapse
Affiliation(s)
- Amanda S Carmel
- Weill Cornell Medical College, Department of Medicine, New York, New York
| | - Peter Steel
- Weill Cornell Medical College, Department of Emergency Medicine, New York, New York
| | - Robert Tanouye
- Weill Cornell Medical College, Department of Emergency Medicine, New York, New York
| | - Aleksey Novikov
- Weill Cornell Medical College, Department of Medicine, New York, New York
| | - Sunday Clark
- Weill Cornell Medical College, Department of Emergency Medicine, New York, New York
| | - Sanjai Sinha
- Weill Cornell Medical College, Department of Medicine, New York, New York
| | - Judy Tung
- Weill Cornell Medical College, Department of Medicine, New York, New York
| |
Collapse
|
22
|
Abstract
Over the past 10 years, postdischarge clinics have been introduced in response to various health system pressures, including the focus on rehospitalizations and the challenges of primary care access. Often ignored in the discussion are questions of the effect of postdischarge physician visits on readmissions. In addition, little attention has been given to other clinical outcomes, such as reducing preventable harm and mortality. A review of dedicated, hospitalist-led postdischarge clinics, of the data supporting postdischarge physician visits, and of the role of hospitalists in these clinics may be instructive for hospitalists and health systems considering the postdischarge clinic environment. Journal of Hospital Medicine 2017;12:467-471.
Collapse
Affiliation(s)
- Lauren Doctoroff
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|