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County Medical Services' (CMS) frequent emergency department users: A collaborative intervention

Steve Hon, MPA1, Liza D. Macatula, MSN1, Jim Price, MPH2, and David Lindsay, MA1. (1) Health and Human Services Agency, County of San Diego, 8840 Complex Dr. #255, San Diego, CA 92123, (858) 492-2250, steve.hon@sdcounty.ca.gov, (2) AmeriChoice, 8840 Complex Dr. #300, San Diego, CA 92123

A significant rise in the number of paid claims for emergency department (ED) treat and release visits prompted a closer examination of the utilization of such services within the County of San Diego’s medically indigent services program – County Medical Services (CMS). In FY 01-02, there were 378 clients with >5 ED visits (1.8% of total unduplicated clients in the system) amounting to 3,313 separate ED visits (22% of total ED visits paid for by CMS). Subsequent analysis of FY 02-03 data yielded similar trend pattern. To determine total impact upon County resources, a data match was requested from County’s Adult Mental Health Services (AMHS), Alcohol and Drug Services (ADS) and Sheriff’s Department. Further analysis revealed that 70% of the ED diagnoses related to pain management. Feedback from ED providers confirmed that this is not an issue unique to the CMS population. Providers expressed concerns of litigation, HIPAA restraints, and low customer satisfaction and accreditation surveys. However, there is a consensus that frequent intermittent access to ED services is poor quality of care especially for pain management. Recommendations include implementation of an alternate pain management program with a process assuring continuity of care and a system that encourages client accountability. Consequently, development of an outpatient pain management program in partnership with a community clinic is in its initial planning stages. Additionally, an ad hoc workgroup is formed with representation from other directly impacted County services, various hospitals and community clinics to discuss other interventions.

Learning Objectives: At the conclusion of the session, the participant will be able to

Keywords: Emergency Department/Room, Utilization

Related Web page: N/A

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Partnerships for Improving Health Services

The 132nd Annual Meeting (November 6-10, 2004) of APHA