Incorporating Alternative Care Site Characteristics Into Estimates of Substitutable ED Visits

Medical Care
Nathan Seth TruegerJesse M Pines

Abstract

Several recent efforts to improve health care value have focused on reducing emergency department (ED) visits that potentially could be treated in alternative care sites (ie, primary care offices, retail clinics, and urgent care centers). Estimates of the number of these visits may depend on assumptions regarding the operating hours and functional capabilities of alternative care sites. However, methods to account for the variability in these characteristics have not been developed. To develop methods to incorporate the variability in alternative care site characteristics into estimates of ED visit "substitutability." Our approach uses the range of hours and capabilities among alternative care sites to estimate lower and upper bounds of ED visit substitutability. We constructed "basic" and "extended" criteria that captured the plausible degree of variation in each site's hours and capabilities. To illustrate our approach, we analyzed data from 22,697 ED visits by adults in the 2011 National Hospital Ambulatory Medical Care Survey, defining a visit as substitutable if it was treat-and-release and met both the operating hours and functional capabilities criteria. Use of the combined basic hours/basic capabilities criteria and ext...Continue Reading

References

May 19, 2009·BMC Health Services Research·Robin M WeinickCatherine M DesRoches
May 27, 2009·Archives of Internal Medicine·Craig Evan Pollack, Katrina Armstrong
Oct 24, 2009·Population Health Management·Tine Hansen-TurtonDavid B Nash
Sep 10, 2010·The American Journal of Emergency Medicine·Anne-Claire DurandRoland Sambuc
Oct 23, 2012·Annals of Emergency Medicine·Linda F McCaig, Catharine W Burt
Apr 23, 2014·JAMA : the Journal of the American Medical Association·Rahul RajkumarMarilyn Tavenner

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Citations

Jan 31, 2018·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jesse M PinesBernard S Black
Jun 17, 2020·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Kirstin W ScottRobert J Blendon
May 28, 2019·Medical Care Research and Review : MCRR·Rahul LadhaniaJesse M Pines
Feb 10, 2021·Health Services Research·Lindsay AllenJason M Hockenberry

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