The Reduction of Emergency Room Visits for Non-Emergent Health Concerns in Bakersfield, California
Mariah Walton, MPH
Public Health Advisor
Office for State, Tribal, Local and Territorial Support
Centers for Disease Control and Prevention
2016 PHAP Spring Seminar
April 7, 2016
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support
BAKERSFIELD, KERN COUNTY
Increased emergency room (ER) visits since 2000
ER usage rate: 366.5 (2000) to 424.4 (2012)
Hospitals operating over capacity
Rise in health care cost
$3 trillion spent on health care
$18 billion wasted in health expenditures
Preventable visits
55% of ER visits are non-urgent
Health centers save the healthcare system over $24 billion through theprovision of effective and efficient care
1.Weiss, Audrey J., Lauren M. Wier, Carol Stocks, and Janice Blanchard. "Overview of Emergency Department Visits in the United States,2011." HCUP Statistical Brief #174. June 2014. Web. 18 Mar. 2016.
2.Ku L, et al. Using primary care to bend the cost curve: Estimating the impact of a health center expansion of health care costs. PolicyResearch Brief No. 14. 2009. Geiger Gibson/RCHN Community Health Foundation Collaborative at the George Washington University.
Why Are Emergency Room (ER)Reduction Programs Important?
California
•ER Discharges: n= 11,562,550
•Gender: Females = 55%; Males = 45%
•Population: White (39%), Hispanic (38%), Black (11.2%), Asian (5%), Other(6%)
Kern County
•ER Discharges: n= 311,348
•Gender: Females = 57%; Males = 44%
•Population: White (40%), Hispanic (47%), Black (9%), Other (2.5%)
Bakersfield
•ER Discharges: n= 267,177
•Gender: Females = 55%; Males = 45%
•Population: White (37%), Hispanic (48%), Black (11%), Other (3.4%)
* Office of Statewide Health Planning and Development. (2014). 2014 California emergency department data
Why Are ER Reduction Programs Important?
What does the trend look like?
OSHPD. (2014)
OSHPD. (2014)
Emergency Medical Services andPublic Health Nursing Divisions
2014 Operations
EMS Database
•Prioritized based on acuitylevel and assigned to aPublic Health Nurse
2015 Operations
Hospital Referrals
•All eligible referralsaccepted and assigned to aPublic Health Nurse
Program Overview
Inclusion Criteria:
Resident of Bakersfield, CA
18 years or older
Accessed emergency resources 10 or more times within a 6 month period
Maximum caseload: 2 patients/ Nurse
Step 1: Planning
Conducted literature reviews of successful ER reduction programs
Developed materials such as logic model, Gantt chart, protocols,and tracking tools
Trained internal and external nursing staff on how to refer and trackimprovements
Developed secured database for monitoring patients’ casemanagement
Developed partner engagement workgroup
Methods
Step 2: Implementation
Collected baseline ER usage data from two hospitals
Public Health Nurses conducted home visits
Created brochures for hospitals to educate patients
Methods
Step 3: Evaluation
Tracked # of received referrals
Tracked patient ER visits during and post-intervention
Tracked services provided
Methods
Program Results
There were 32 patients referred and18 eligible for case management.
241 total ER visits for the 18 enrolledpatients
83% (n=15) were insured by Medi-Cal,Medicare, or Private Insurance
Complex health concerns
Mental Health
Substance abuse and/or alcoholism
Hypertension
Diabetes
Gastritis
Patient Demographics
Gender
Male
6
33%
Female
12
66%
Race
White
9
50%
Hispanic
7
38%
Black
2
11%
Average age: 49
Program Results
Each patient linked to one or more of the following services:
Primary Care Provider
Health insurance
Transportation
Life skills programs
Mental health
Housing
Disease management
Program Results
Successes
Improved quality of life for 7 residents
Reduced ER visits by 68% (n=241 to n=77)
Decreased average cost per patient/visit by 89% (n=$5,010to n=$567)
Administrative successes
Implications
Competing priorities
Inadequate staffing (internal & external)
Lack of partner commitment
Insufficient data sharing methods or fragmented data
Sustainable funding methods
Next Steps
Coordinate with the local health insurance agency to identifyfrequent users
Partner with mental health to assist with home visitassessments
Develop program for residents between 6 - 17 years old
Invest in a Health Information Exchange (HIE) system anddevelop policies
For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support
4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of theCenters for Disease Control and Prevention.
Centers for Disease Control and Prevention
Office for State, Tribal, Local and Territorial Support