Emergency department (ED) visits are not distributed equally amongst all patients; approximately 8% of patients are responsible for 28% of all ED visits.2-4 Frequent users of ED services are of significant concern as their healthcare needs are not adequately being met by the standard care system resulting in increased healthcare costs and the potential to impact the quality of care provided to all ED patients.1 While frequent ED users are a heterogeneous population, little is known about ways to classify frequent ED users along resource use into specific groups amenable to goal-directed interventions. Understanding frequent ED user groups will guide the development of targeted interventions to effectively assist these complex patients, improve the quality of patient care, and lower healthcare resource use. The Denver Health Medical Center, a model public, academic healthcare system, 40 recently created an ambulatory intensive caring unit, the DHMC Intensive Outpatient Clinic (IOC), in which high-utilizing patients receive all of their outpatient care in the IOC. The goal o the clinic is to maintain a high quality of care and decrease hospitalizations. We believe that the IOC is a prime target for evaluation as a natural experiment to assess whether components of the IOC are effective at reducing recurrent ED visits and avoiding overutilization of healthcare resources. The first hypothesis is that distinct categories of frequent ED users with differing characteristics and clusters of ED resource use exist that will be amenable to tailored, targeted interventions to reduce healthcare resource use and improve the quality of patient care. The second hypothesis are that specific IOC services provided to frequent ED users do result in fewer ED visits and that the IOC will be demonstrated to have reach, efficacy, adoption, implementation, and maintenance for frequent ED users. The third hypotheses are that a pilot intervention for frequent ED users will be feasible in the Denver Health ED; the intervention will be adopted and achievable in the ED while being useful and timely for providers and participants.
The Specific Aims therefore include: (1) to create a taxonomy of frequent ED users and the services they utilize; (2) refined by the taxonomy identified in Aim 1, to evaluate the impact of the DHMC IOC on frequent ED visits; and (3) to design and implement a pilot intervention in the Denver Health ED targeted specifically at decreasing ED visits and avoiding overutilization based upon lessons learned from the IOC.
This project will investigate ways to potentially improve quality of care for complex patients who have frequent visits to the emergency department. The project will advance our understanding of ways to manage and improve care for complex patients with significant healthcare needs which is important for patients, healthcare providers, and policy makers.
| Rinehart, Deborah J; Oronce, Carlos; Durfee, Michael J et al. (2018) Identifying Subgroups of Adult Superutilizers in an Urban Safety-Net System Using Latent Class Analysis: Implications for Clinical Practice. Med Care 56:e1-e9 |
| Joseph, Daniel; Vogel, Jody A; Smith, C Sam et al. (2018) Alcohol as a Factor in 911 Calls in Denver. Prehosp Emerg Care 22:427-435 |
| Ranney, Megan L; Fletcher, Jonathan; Alter, Harrison et al. (2017) A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research. Ann Emerg Med 69:227-240 |
| Kessler, Ross; Stowell, Jeffrey R; Vogel, Jody A et al. (2016) Effect of Interventional Program on the Utilization of PACS in Point-of-Care Ultrasound. J Digit Imaging 29:701-705 |
| Rising, Kristin L; Carr, Brendan G; Hess, Erik P et al. (2016) Patient-centered Outcomes Research in Emergency Care: Opportunities, Challenges, and Future Directions. Acad Emerg Med 23:497-502 |
| Vogel, Jody A; Newgard, Craig D; Holmes, James F et al. (2016) Validation of the Denver Emergency Department Trauma Organ Failure Score to Predict Post-Injury Multiple Organ Failure. J Am Coll Surg 222:73-82 |
| Vogel, Jody A; Kendall, John (2015) The authors reply. Crit Care Med 43:e473-4 |
| Vogel, Jody A; Kendall, John (2015) The authors reply. Crit Care Med 43:e597-8 |
| Vogel, Jody A; Kendall, John (2015) The authors reply. Crit Care Med 43:e396 |
