2011 Study of Emergency Services Utilization in the Capital Region of NY Kevin Jobin-Davis, PhD

2011 Study of Emergency Services Utilization in the Capital Region of NY

Kevin Jobin-Davis, PhD

R5 Initiative— Improving Access to the Right Care in the Right Place at the Right Time

for the Right Reason at the Right Cost

HCDI Members

County Health Departments Health Plans Albany County Department of Health Capital District Physicians’ Health Plan Rensselaer County Department of Health Fidelis Care New York Schenectady County Public Health Services Senior Whole Health

Hospitals Federally Qualified Health Centers

Ellis Hospital Hometown Health ServicesAlbany Medical Center Whitney M. Young, Jr. Health ServicesSeton Health/St. Mary’s Hospital St. Peter’s Health Care ServicesNortheast Health/Samaritan Hospital/Albany Memorial Hospital

Community PartnersCatholic Charities of the Catholic Diocese of Albany

Healthy Capital District Initiative | www.hcdiny.org

HCDI – Improving Access to Health Services

Public Health Insurance Free application assistance for Medicaid, CHP, FHP – 4,200

people served annually Community Health Advocates - information and assistance

accessing health insurance and health services

Seal A Smile School-based Dental Services Preventative oral health services – 3,250 served annually

Poverello Center Primary Care for Uninsured Adults – 350 served annually


Public Health Planning

Analyze available State & Local Health Data Collect and Analyze local data Support County and Hospital health

planning requirements – CHA and CSP Develop local and regional initiatives

to address targeted health needs


Target Population: Sub-optimal ER Users

Suboptimal ED Use

Non-emergent Frequent flyers Preventable and chronic illness

Individual Forces

PainKnowledge of

health resourcesWork conflictsTransportationSocial support

Health System Forces

Primary care availability

Referral policiesSupport services Intake/discharge

policies Inter-organization

communication

The R5 InitiativeImproving Access to the Right Care in the Right Place at the Right Time for the Right reason at the Right Cost


6 Healthy Capital District Initiative | www.hcdiny.org

R5 Goals

Identify causes of sub-optimal ED use Identify promising practices and facilitate wider

adoption in the Capital Region Improve patient & provider engagement with primary,

preventive, and managed care through collaborative interventions, resulting in better health outcomes

Collaboratively develop protocols to improve patient flow through the health system

Healthy Capital District Initiative | www.hcdiny.org7

2008 Capital District Emergency Department Visits


ICD9 Diagnosis Total

Acute URI NOS (#1 PCR Diagnosis for All & Children) 4,148Urinary Tract INF NOS (#1 PCR Diagnosis for Women & Seniors) 3,205Acute Bronchitis 3,040Abdominal Pain-Site NOS 3,035Dental Disorder NOS (#1 Non-Emergent Diagnosis) 2,983Asthma NOS W Exacer 2,956Otitis Media NOS 2,835NonINF Gastroent NEC&NOS 2,719Viral Infection NOS 2,691Acute Pharyngitis 2,686Grand Total 30,298

Top 10 Primary Care-Related Diagnoses


Top 10 Non-Emergent Diagnoses

ICD9 Diagnosis Total

Dental Disorder NOS 2,677Headache 2,172Lumbago 2,146Oth CCE Comp Preg-AP 1,810Acute Pharyngitis 1,767Urinary Tract INF NOS 1,479Pain in Limb 1,421Viral Infection NOS 1,383Backache NOS 1,344Migraine NOS W/O Sm 1,293Grand Total 17,493

Top 10 Non-Emergent Diagnoses

0%

10%

20%

30%

40%

50%

60%

70%

Private Insurance Medicaid Self Pay Medicare Black Other White

Primary Care Related Emergency Department Visits

% Sub-Population VisitsPrimary Care-Related

% All Primary Care-Related ED Visits



Consumer Survey

HCDI developed a voluntary, anonymous consumer survey to be distributed in local EDs to determine the key factors that affect a person's decision to choose an ED for health care

575 surveys were collected from Albany Memorial, Ellis, Samaritan, Albany Medical Center and St. Peter’s

Surveys contain a combination of open-ended and multiple choice questions on Likert scale


Results Reporting

Open Ended Questions Top Reason and Top 3Health Condition vs. Provider CharacteristicsWhy this Particular Emergency Department

Closed Ended Questions5 point Likert ScaleStrongly Disagree to Strongly Agree


Consumer Themes for Selecting Emergency Care

Table I: Top Reason Patients Chose ED for Care

Theme % Respondents Responses

Health Condition Characteristics 50% 287

Convenience 17% 97

Provider Service Quality 15% 84

Doctor Referral 9% 50

Other 10% 57

Table II: Top 3 Reasons Patient Chose ED for Care



Convenience 53% 304



Other 29% 165


More Specific Factors for Selecting Emergency Care

Table III: Health Condition Factors in Top 3 ED Use Reasons

Factor % Respondents Responses

Symptoms 53% 305

Pain 34% 197

Severity / Urgency 11% 62

Unintentional Injuries 3% 15

Provider Related Factors in Top 3 ED Use Reasons

Factor % Respondents Responses

Quality of Care 40% 231

Proximity 21% 122

Quickness 17% 100

Hours of Operation 14% 82

Medical Referral 12% 67


Factors in Selection of Particular Hospital’s Emergency Services

Table IV: Primary Reasons Patients Selected Particular ED by Theme


Convenience 52% 277


Prior Visits 26% 139


Stated No 4% 20


Other 14% 77


Consumer Defined Rationale for Choosing Emergency Services

Overall, symptoms and convenience are the driving factors for people to seek care

Pain and the quality of care are important secondary considerations

Selection of particular emergency service providers, is similarly influenced by convenience, then service quality factors, with prior visit experience also a consideration


Most Commonly Shared Reasons for Seeking Emergency Services

Symptoms as Motivation for ED Visit Strongly Agree or Agree

Needed care immediately 89%Needed care that day 84%Needed care within 2 days 53%Pain was primary motivation for visit 76%

Service Qualities as Motivation for ED Visit Strongly Agree or Agree

Specialists, lab tests, and x-rays all at one place 80%Do not need an appointment at ED – timely service 73%ED accepts all patients regardless of insurance coverage 68%Cost of ED co-pay was not a concern 37%


Phone Triage and Access Issues

Consulted with Medical Personnel Prior to ED Visit Strongly Agree or Agree

Consulted primary care doctor before going to ED 25%Consulted a nurse help-line before going to the ED 16%Staff at residential facility referred to the ED 13%Ambulance transported to ED 11%

Access to Other Health Providers Strongly Agree or Agree

Hospital is easier to get to than doctor's office 57%No transportation to doctor's office 14%No transportation to urgent care center 14%


Consideration of Urgent Care, Primary Care, and Emergent Care

Considered Urgent Care Centers Prior to ED Visit Strongly Agree or Agree

Considered urgent care centers 28%Unsure of urgent care centers' hours 21%Urgent care centers closed 20%

Prefer ED as Primary Provider Strongly Agree or Agree

Usually use ED for health care 20%ED better place to get health care than a primary care doctor 20%

The Convenience of Accessing Emergency Care


Service Qualities as Motivation for ED VisitStrongly Agree

or Agree

Specialists, lab tests, and x-rays all at one place 80%Do not need an appointment at ED – timely service 73%ED accepts all patients regardless of insurance coverage 68%Hospital is easier to get to than doctor's office 57%Considered urgent care centers 28%

The Inconvenience of Accessing Primary Care


Availability of Primary Care ProviderStrongly Agree

or Agree

Do not have a primary care provider 33%Without prior well doctor visit, doctor wouldn't allow sick visit 14%No doctor appointment available within 2 days 35%Doctor's office was closed 34%Unsure of doctor's office extended hours 24%


Summary of Patient Reasons for Selecting Emergency Health Services

The sense of urgency (84%) and pain (76%) associated with the trauma is the primary motivation for seeking emergency services The convenience of comprehensive, timely services regardless of insurance are the major draws for patientsPatients don’t distinguish clearly emergent from primary care treatable conditions (42% of ED visits)The vast majority (80%) do not consider the ED a better source of care than primary careNot establishing a primary care provider was a factor for 1 in 3 respondents


Methods of Gap Analysis

Discussion/Meetings – 35 different providers (e.g., primary care physicians,

emergency department (ED) nurses, patient navigators, case managers, urgent care clinic nurses, medical directors, discharge planners, long-term care providers, and others

Surveys – 13 primary care doctors – 3 hospitals – 4 nursing facilities– 3 urgent care centers

26


Major Gaps

Care management Patient handoff Capacity Protection from liability Alternatives to the ED

Primary Care Providers (PCP)

Capacity and support for timely preventive care is lacking

– Same day appointments at primary care offices limited

Payment systems do not support robust primary care – No reimbursement for extra time managing care

There are extra challenges for the publicly insured – Some PCPs don’t accept MA; wait before seeing PCP

PCP shortages are acute for certain health conditions – Dental, mental health, and substance abuse were cited often


Hospitals

EDs are not geared to manage care– Focus is emergent care, not chronic care

There are barriers to effective follow-up– Little time to educate patient; limited record

exchange


Hospital / PCP Care Coordination Findings

EDs communicate with affiliated physicians EDs communicate with PCP re: admissions FQHCs typically must actively seek info Other instances, follow-up left to patient


Long Term Care / EMS

Senior housing can’t manage residents’ health or provide services

Many home and community-based providers fear liability if they don’t send patients to the ED

If called, EMS must take patients to the ED


Urgent Care Centers (UCCs) and Federally Qualified Health Centers

(FQHCs)

There is not widespread awareness about UCCs or FQHCs as an alternative to the ED

UCCs not located in urban areas Certain diagnostics only available at ED Service hours are limited


What to Do?

Improve Access to Primary and Preventive CareHelp Consumers Distinguish Primary Care Treatable Conditions from EmergentBolster Communication between Emergency Departments and PCPs


ACCESS TO PRIMARY AND PREVENTIVE CARE

Facilitated Enrollment education on importance of primary care/well visit and assistance with securing PCP

Development of evening primary care services in urban centers

CONSUMER SELECTION OF HEALTH SERVICES

Develop messaging and materials on benefits of primary care to support referrals of ED patients without a PCP

Targeted outreach in areas with high self-pay population

Develop marketing campaign on the benefits of Primary Care

COMMUNICATION BETWEEN EMERGENCY DEPARTMENTS AND OTHER PROVIDERS

Launch pilot exchange of ED visit information with primary care group

Enhance referral processes of ED patients without a PCP to primary care

Contact

Healthy Capital District Initiative315 Sheridan Ave.Albany, NY 12206www.hcdiny.org/r5.htm

Kevin Jobin-Davis(518) [email protected]


2011 Study of Emergency Services Utilization in the Capital Region of NY Kevin Jobin-Davis, PhD

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Transcript of 2011 Study of Emergency Services Utilization in the Capital Region of NY Kevin Jobin-Davis, PhD