208412 Express care and case management: A model to relieve the burden of hospital emergency departments providing primary care services

Monday, November 9, 2009: 11:30 AM

Firoozeh Molaparast Vali, PhD , Vice President, Research, New Jersey Hospital Association/HRET, Princeton, NJ
Jennifer Barrett Sryfi, MHA , Director, Community Programs - Research Department, New Jersey Hospital Association, Princeton, NJ
This demonstration project, funded by CMS, is designed to provide alternate non-emergency services to patients who use hospital emergency departments for primary care needs and encourage their future use of an appropriate and cost-effective care site. The program model involves partnership of a community hospital and a nearby FQHC (or other primary care provider) to make process changes necessary for a more efficient system addressing needs of culturally diverse communities. In this model, once an ED patient is identified with primary care needs following triage/screening per EMTALA, an advanced practice nurse provides express care services/prescriptions, and sets up the follow-up appointment with a primary care provider in the community, using a secure Web-based electronic information system. As part of discharge services for Medicaid/uninsured patients, the APN will identify patient barriers and educate them on importance of using appropriate site of care for primary care services, limiting ED visits to true emergency situations. Case managers will also monitor ED utilization, track compliance with follow-up visits, identify repeat ED users, and work with the partner FQHC to help patients resolve barriers, find a more accessible permanent medical home and get linked with intensive chronic disease management programs. The project is piloted in two sites, located in medically-underserved counties with high rate of ED use by Medicaid beneficiaries. The evaluation measures and anticipated outcomes include reduced hospital ED use for primary care services; reduced hospitalizations for chronic diseases complications or ACS conditions; increased capacity of primary healthcare system; and cost savings for Medicaid.

Learning Objectives:
At the conclusion of the session, the participants will be able to: 1) Explain the issues and consequences of use of hospital emergency departments for primary care services; 2) Describe components of the demonstration project model; 3) Summarize the projectís strategies to improve efficiency in hospital emergency departments; 3) Describe projectís implementation plans and pilot sites; 3) Describe the projectís evaluation plans, as well as the measures used to assess its outcomes and impacts; and 5) Summarize the preliminary findings, next step plans and possible future expansion.

Keywords: Emergency Department/Room, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am trained as a medical sociologists and health services resaercher and am in charge of a dept conducting health services research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.