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EMS and managed care: the Los Angeles experience
Marc Eckstein1, Martin Talamo, Sean O Henderson
1Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. eckstein@usc.edu
Prehospital Emergency Care
|February 11, 2010
Summary
Transporting managed care organization (MCO) patients to the nearest MCO emergency department (ED) instead of the closest ED is safe and feasible. This approach may improve patient care by ensuring access to medical records and follow-up.
Area of Science:
- Emergency Medicine
- Healthcare Management
- Public Health
Background:
- Managed care organization (MCO) patients calling 9-1-1 are typically routed to the closest emergency department (ED), even if it's not an MCO facility.
- Non-MCO facilities may lack patient medical history and follow-up capabilities, potentially leading to unnecessary tests and admissions.
Purpose of the Study:
- To evaluate the safety and feasibility of directing MCO patients to the nearest MCO emergency department (ED) over the closest available ED.
- To assess the impact of this transport protocol on patient outcomes and healthcare resource utilization.
Main Methods:
- A retrospective review of 15,938 patients transported by ambulance over 52 months.
- Comparison between patients preferentially transported to an MCO ED (targeted group) and all other transported patients.
- Analysis of additional ambulance transport time and 24-hour mortality rates. EMS providers received additional reimbursement for non-closest MCO ED transports.
Main Results:
- The mean transport time for the targeted group was 10.4 minutes, compared to 8.6 minutes for the control group (p < 0.001).
- No patients required field ventilatory support.
- A total of 12 patients (0.1%) died during admission; none of the deaths were attributed to the additional transport time after blinded chart review.
Conclusions:
- Paramedic transport of MCO patients to the nearest MCO hospital, even if not the closest ED, is safe and feasible.
- This protocol shows potential benefits for patient care and warrants evaluation in other emergency medical services (EMS) systems.
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