Chronically Ill Patients Frequent EDs More Than Behavioral Health Patients

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By Jennifer Van Winkle 
Clinical Product Manager, Change Healthcare
A doctor using healthcare predictive modeling

Given the cost to run an emergency department (ED), keeping visits confined to accidents, injuries and one-time acute episodes are keys to helping lower healthcare costs overall. In other words, getting care for so-called “frequent flyers” in any setting less costly than the ED would be a major accomplishment.

For years, the focus was on the mentally ill, with the belief that they made up the majority of frequent ED visitors. But a study in Health Affairs dispels that assumption, finding that ED super users most often suffer from one or more chronic illnesses. The research is based on an analysis of just under 212,300 visits to New York City EDs in 2007.

Shifting Focus to Chronic Conditions

This finding has a couple important ramifications. First, the study authors say healthcare predictive modeling can identify who will become a repeat ED user. Using predictive modeling could get chronically ill patients the care they need in a less expensive setting.

Second, home health organizations can play a key role in this effort. As home care executives know, your organizations are expert at caring for the chronically ill with programs that help to lower the need for emergency care, including:

  • Care coordination
  • Vital sign monitoring
  • Patient education
  • Medication adherence
  • Discharge instruction adherence
  • Diet and exercise
  • Telephone consultation

How Home Health Can Help Reduce ED Visits and Healthcare Costs

Among other things, home health organizations can send nurses or aides to the home on as-needed basis. In addition to telling newly discharged patients what they need to do to avoid a trip to the emergency room, workers can urge hospital discharge staffers to make at least one visit to the home to ensure its safety and that the patient knows how to take his meds.

Data plays a vital role, too. Actionable data gleaned from the home is essential for reducing emergency room visits, particularly for seniors and individuals with chronic illnesses. Care managers, including those from home health organizations, can use tools that effectively integrate in-home clinical and behavioral information to determine who is at risk of an ED visit.

Local organizations are getting in the data act in innovative ways. In Camden, New Jersey, the Camden Coalition of Healthcare Providers is collecting and analyzing data from a variety of sources, including ambulance calls, conversations with doctors and patient records, to spot those patients who are super users of hospital services and deploy interventions, such as the services of home health providers, that will keep those people out of the emergency room.

Telemedicine, where care sites exchange medical information through electronic communication tools such as two-way video, smartphones, and satellite and wireless tools, is gaining ground among home health organizations and other care providers because they deliver customizable remote patient monitoring services that can detect disease-related, clinical early warning signs so that actions can be taken to avoid ER visits.

As the focus shifts from behavioral health to the chronically ill, home health organizations should effectively communicate to their clinical partners their knowledge and skills in these areas.  By helping to reduce the number of ED frequent flyers, these leading organizations consequently will help reduce emergency department costs and overcrowding.

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