National Clinician Scholars Program at the University of Pennsylvania and Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Penn Medicine Center for Health Care Innovation, University of Pennsylvania, USA.
Healthc (Amst). 2021 Sep;9(3):100545. doi: 10.1016/j.hjdsi.2021.100545. Epub 2021 Apr 23.
We sought to determine the feasibility of the Practical Alternative to Hospitalization (PATH) program, an intervention that offers ED clinicians an outpatient care pathway for patients initially designated for inpatient admission or observation.
We evaluated a novel care delivery model that was piloted at a tertiary academic medical center in December 2019. An advanced practice provider screened patients designated for inpatient admission or observation and identified eligible participants. Outpatient services were customized for each patient but primarily included care coordination and monitoring through telemedicine and home health services. The primary feasibility outcome was the proportion of eligible patients who were enrolled in the program, as well as patient outcomes after discharge including return ED visits and averted ED boarding time.
A total of 199 patients were designated for inpatient admission or observation during PATH program hours. Of 52 eligible patients, 30 (58%) were enrolled. The mean participant age was 62.5 years (SD 17.5), and 25 (83%) had non-Hispanic Black race/ethnicity. The most common disease conditions were chest pain, heart failure, and hyperglycemia. 4 (13%) enrolled patients returned to an ED within 30 days. We estimate that ED boarding time was reduced by 8.2 h (SD 8.1) per patient.
Emergency physicians and patients were willing to use a novel service that provided an alternative disposition to hospitalization.
alternative payment models that seek to reduce hospital utilization and cost may consider strengthening systems to monitor and coordinate care for patients after ED discharge.
我们旨在确定实用替代住院（PATH）计划的可行性，该计划为 ED 临床医生提供了一种门诊护理途径，适用于最初被指定住院或观察的患者。
我们评估了一种新的护理提供模式，该模式于 2019 年 12 月在一家三级学术医疗中心进行试点。一名高级执业医师筛选被指定住院或观察的患者，并确定符合条件的参与者。门诊服务为每位患者量身定制，但主要包括通过远程医疗和家庭健康服务进行护理协调和监测。主要可行性结果是符合条件的患者中参与该计划的比例，以及出院后的患者结局，包括返回急诊部就诊和避免急诊部候诊时间。
在 PATH 计划时间内，共有 199 名患者被指定住院或观察。在 52 名符合条件的患者中，有 30 名（58%）入组。参与者的平均年龄为 62.5 岁（SD 17.5），25 名（83%）为非西班牙裔黑人。最常见的疾病状况是胸痛、心力衰竭和高血糖。4 名（13%）入组患者在 30 天内返回急诊部。我们估计每位患者的急诊部候诊时间减少了 8.2 小时（SD 8.1）。
急诊医生和患者愿意使用一种提供替代住院的新服务。
寻求减少医院利用和成本的替代支付模式可能会考虑加强系统，以监测和协调急诊部出院后的患者护理。
