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The impact on emergency department utilization and patient flows after integrating with a general practitioner cooperative: an observational study.

Thijssen WA, Wijnen-van Houts M, Koetsenruijter J, Giesen P, Wensing M - Emerg Med Int (2013)

Bottom Line: Conclusion.ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up.This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients.

View Article: PubMed Central - PubMed

Affiliation: Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602ZA NB Eindhoven, The Netherlands ; IQ Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, IQ P.O. Box 9101, Healthcare 114, 6500HBGLO Nijmegen, The Netherlands ; Emergency Department, Catharina Hospital, Eindhoven P.O. Box 1350, 5602ZA NB Eindhoven, The Netherlands.

ABSTRACT
Introduction. A new model, an emergency care access point (ECAP) for after-hours emergency care, is emerging in The Netherlands. This study assessed the effect on emergency department (ED) utilization and patient flows. Methods. Routinely recorded clinical ED patient data, covering a six-year period, was collected. Segmented regression analysis was used to analyze after-hours changes over time. Results. 59.182 patients attended the ED before the start of the ECAP and 51.513 patients after, a decrease of 13%. Self-referred ED patients decreased 99.5% (OR 0.003; 95% CI 0.002-0.004). Referred patients increased by 213.4% and ED hospital admissions increased by 20.2%. A planned outpatient follow-up increased by 5.8% (OR 1.968 95% CI 1.870-2.071). The latter changed from fewer contacts to more contacts (OR 1.015 95% CI 1.013-1.017). Consultations at the regional genereral practitioner cooperative (GPC) increased by 26.0% (183.782 versus 232.246). Conclusion. ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up. This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients. Overall, increased collaboration with after-hours primary care and emergency care seemed to optimize ED utilization.

No MeSH data available.


Related in: MedlinePlus

Distribution of patients origin. For visual reasons the percentage of revisits, referrals from outpatient clinics or other hospitals is not shown in this figure.
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fig2: Distribution of patients origin. For visual reasons the percentage of revisits, referrals from outpatient clinics or other hospitals is not shown in this figure.

Mentions: For the comparison of descriptive characteristics of patients before and after the start of the ECAP, we used the chi-square test. We calculated numbers and percentages. A logistic segmented regression analysis was performed to test the changes after implementation of the ECAP as shown in Figures 2 and 3. This method estimates separately the change over time before the intervention, the direct effect of the intervention itself, and the change over time after the intervention. P < 0.05 was considered significant. Outcome variables were self-referrals versus non-self-referrals and an outpatient clinical follow-up contact versus no clinical follow-up contact (the combined categories of no follow-up contact and a GP follow-up contact). The regression model controlled for the effect of age and gender. We used SPSS 19.0 for our statistical analysis.


The impact on emergency department utilization and patient flows after integrating with a general practitioner cooperative: an observational study.

Thijssen WA, Wijnen-van Houts M, Koetsenruijter J, Giesen P, Wensing M - Emerg Med Int (2013)

Distribution of patients origin. For visual reasons the percentage of revisits, referrals from outpatient clinics or other hospitals is not shown in this figure.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3814098&req=5

fig2: Distribution of patients origin. For visual reasons the percentage of revisits, referrals from outpatient clinics or other hospitals is not shown in this figure.
Mentions: For the comparison of descriptive characteristics of patients before and after the start of the ECAP, we used the chi-square test. We calculated numbers and percentages. A logistic segmented regression analysis was performed to test the changes after implementation of the ECAP as shown in Figures 2 and 3. This method estimates separately the change over time before the intervention, the direct effect of the intervention itself, and the change over time after the intervention. P < 0.05 was considered significant. Outcome variables were self-referrals versus non-self-referrals and an outpatient clinical follow-up contact versus no clinical follow-up contact (the combined categories of no follow-up contact and a GP follow-up contact). The regression model controlled for the effect of age and gender. We used SPSS 19.0 for our statistical analysis.

Bottom Line: Conclusion.ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up.This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients.

View Article: PubMed Central - PubMed

Affiliation: Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602ZA NB Eindhoven, The Netherlands ; IQ Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, IQ P.O. Box 9101, Healthcare 114, 6500HBGLO Nijmegen, The Netherlands ; Emergency Department, Catharina Hospital, Eindhoven P.O. Box 1350, 5602ZA NB Eindhoven, The Netherlands.

ABSTRACT
Introduction. A new model, an emergency care access point (ECAP) for after-hours emergency care, is emerging in The Netherlands. This study assessed the effect on emergency department (ED) utilization and patient flows. Methods. Routinely recorded clinical ED patient data, covering a six-year period, was collected. Segmented regression analysis was used to analyze after-hours changes over time. Results. 59.182 patients attended the ED before the start of the ECAP and 51.513 patients after, a decrease of 13%. Self-referred ED patients decreased 99.5% (OR 0.003; 95% CI 0.002-0.004). Referred patients increased by 213.4% and ED hospital admissions increased by 20.2%. A planned outpatient follow-up increased by 5.8% (OR 1.968 95% CI 1.870-2.071). The latter changed from fewer contacts to more contacts (OR 1.015 95% CI 1.013-1.017). Consultations at the regional genereral practitioner cooperative (GPC) increased by 26.0% (183.782 versus 232.246). Conclusion. ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up. This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients. Overall, increased collaboration with after-hours primary care and emergency care seemed to optimize ED utilization.

No MeSH data available.


Related in: MedlinePlus