Christian D Pulcini1, Ryan J Coller2, Amy J Houtrow3, Zoe Belardo4, Joseph J Zorc5. 1. Division of Emergency Medicine, Department of Surgery, University of Vermont (CD Pulcini), Burlington, Vt. Electronic address: Christian.pulcini@uvm.edu. 2. Department of Pediatrics, University of Wisconsin-Madison (RJ Coller), Madison, Wis. 3. Department of Physical Medicine and Rehabilitation, University of Pittsburgh (AJ Houtrow), Pittsburgh, Pa. 4. University of Pennsylvania (Z Belardo), Philadelphia, Pa. 5. Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia (JJ Zorc), Philadelphia, Pa.
Abstract
BACKGROUND: Children with medical complexity (CMC) represent a growing population with high emergency department (ED) utilization. How to reduce preventable ED visits is poorly understood. OBJECTIVE: We sought to determine what components of ambulatory care programs focused on CMC were most effective in preventing ED visits. DATA SOURCES: PubMed Plus, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases through October 2019, and hand search of bibliographies. STUDY ELIGIBILITY CRITERIA: Two independent reviewers used a structured screening protocol to include English language articles summarizing studies that included CMC, emergency care, or ED utilization. Data on ED utilization were extracted. RESULTS: Sixteen included studies described outpatient interventions to prevent ED utilization. Of these, studies that included 24/7 access to knowledgeable providers for acute care needs by phone (telehealth) or expedited or next-day appointments were the most consistently successful in reducing ED visits. LIMITATIONS: Risk of bias was mixed across studies. The evidence base is currently small and observational nature of interventions and their evaluations limit definitive, generalizable recommendations. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Current research suggests that real-time access to knowledgeable providers and expedited appointments can prevent ED visits. Further study is needed to generalize these findings as well as investigate novel strategies such as telehealth to improve quality of care, decrease utilization, and provide cost-effective care for this vulnerable population.
BACKGROUND:Children with medical complexity (CMC) represent a growing population with high emergency department (ED) utilization. How to reduce preventable ED visits is poorly understood. OBJECTIVE: We sought to determine what components of ambulatory care programs focused on CMC were most effective in preventing ED visits. DATA SOURCES: PubMed Plus, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases through October 2019, and hand search of bibliographies. STUDY ELIGIBILITY CRITERIA: Two independent reviewers used a structured screening protocol to include English language articles summarizing studies that included CMC, emergency care, or ED utilization. Data on ED utilization were extracted. RESULTS: Sixteen included studies described outpatient interventions to prevent ED utilization. Of these, studies that included 24/7 access to knowledgeable providers for acute care needs by phone (telehealth) or expedited or next-day appointments were the most consistently successful in reducing ED visits. LIMITATIONS: Risk of bias was mixed across studies. The evidence base is currently small and observational nature of interventions and their evaluations limit definitive, generalizable recommendations. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Current research suggests that real-time access to knowledgeable providers and expedited appointments can prevent ED visits. Further study is needed to generalize these findings as well as investigate novel strategies such as telehealth to improve quality of care, decrease utilization, and provide cost-effective care for this vulnerable population.
Keywords:
Child; Chronic Disease; Emergency Medical Services; Pediatrics; children with medical complexity; complex chronic disease; emergency department
Authors: Jessica L Bettenhausen; Clemens Noelke; Robert W Ressler; Matthew Hall; Mitch Harris; Alon Peltz; Katherine A Auger; Ronald J Teufel; Jeffrey E Lutmer; Molly K Krager; Harold K Simon; Mark I Neuman; Padmaja Pavuluri; Rustin B Morse; Pirooz Eghtesady; Michelle L Macy; Samir S Shah; David C Synhorst; James C Gay Journal: Acad Pediatr Date: 2021-12-17 Impact factor: 2.993