Robinson Melody M, Stone Gregory, Tokarz Stephanie, Wortham Benjamin
Clinical Transformation Portfolio, Louisiana Public Health Institute, New Orleans, Louisiana (Ms Robinson and Dr Stone); Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Ms Tokarz); and Catholic Charities Archdiocese of New Orleans, New Orleans, Louisiana (Mr Wortham).
J Public Health Manag Pract. 2017 Nov/Dec;23 Suppl 6 Suppl, Gulf Region Health Outreach Program:S54-S58. doi: 10.1097/PHH.0000000000000666.
Emergency departments (EDs) have become the primary source of care for increasing number of patients, leading to treatment of nonemergent cases, which divert resources from true emergency situations and represent poor cost-effectiveness for treating such cases. There is evidence that suggests that patient navigation (PN) integrated into the ED and other case management techniques can help reduce the number of primary care-related ED visits and these navigation programs are more cost-effective than the ED visits themselves. The Greater New Orleans Community Health Connection Primary Care Capacity Project Quality Improvement Initiative (GNOPQii) is a pilot project aimed at improving the efficiency of PN for patients who have had avoidable ED encounters or inpatient readmissions through applied data and technology program.
Partnering Federally Qualified Health Centers were equipped with actionable ED utilization data to integrate with their own patient clinical data to track patient ED activity. The pilot design also included the use of patient navigators to address the nonclinical cultural and behavioral barriers to care. As part of the overall evaluation, comparisons of data utilization and PN services pre- and post-GNOPQii were conducted.
A total of 337 referrals were made, and 145 patients were enrolled into the GNOPQii pilot program. The direct services needed the most by patients were transportation and medication resources. Of those who enrolled (N = 145), 63 patients graduated, meaning program compliance and 90 days without visits to the ED, resulting in a 43% success rate.
If an estimated $1898 savings for every nonemergency ED encounter replaced by an office-based encounter is applied to our results, the GNOPQii program contributed to a minimum of $119 574.00 savings even if only 1 deterred ED visit per graduate is assumed. Future research is needed to systematically test the efficacy of GNOPQii in reducing nonemergent ED visits.
急诊科已成为越来越多患者的主要护理来源，导致非紧急病例的治疗，这从真正的紧急情况中转移了资源，并且治疗此类病例的成本效益不佳。有证据表明，将患者导航（PN）整合到急诊科和其他病例管理技术中，可以帮助减少与初级护理相关的急诊科就诊次数，并且这些导航计划比急诊科就诊本身更具成本效益。大新奥尔良社区健康连接初级护理能力项目质量改进计划（GNOPQii）是一个试点项目，旨在通过应用数据和技术计划提高对有可避免的急诊科就诊或住院再入院患者的PN效率。
与联邦合格健康中心合作，配备可操作的急诊科利用数据，以与他们自己的患者临床数据整合，以跟踪患者的急诊科活动。试点设计还包括使用患者导航员来解决护理的非临床文化和行为障碍。作为总体评估的一部分，对GNOPQii前后的数据利用和PN服务进行了比较。
共进行了337次转诊，145名患者被纳入GNOPQii试点项目。患者最需要的直接服务是交通和药物资源。在登记的患者中（N = 145），63名患者毕业，即符合项目要求且90天内未就诊急诊科，成功率为43%。
如果将每次由门诊就诊取代的非紧急急诊科就诊估计节省的1898美元应用于我们的结果，即使假设每位毕业生仅阻止1次急诊科就诊，GNOPQii项目至少节省了119574.00美元。未来需要进行研究，以系统地测试GNOPQii在减少非紧急急诊科就诊方面的疗效。
