Non-emergency department interventions to reduce ED utilization: a systematic review

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• Recent health policy shifts emphasize reducing emergency department (ED) visits to control costs and enhance care quality.
• Interventions implemented outside the ED are being explored as a strategy to decrease ED utilization.

Purpose of the Study:

• To systematically review interventions performed outside the emergency department (ED) that aim to reduce ED use.
• To evaluate the effectiveness of various intervention categories on ED utilization.

Main Methods:

• Systematic review of studies published in English, focusing on interventions outside the ED with a comparison group.
• Literature search conducted across MEDLINE, Cochrane, OAIster, and Scopus databases.
• Data abstraction included intervention type, study design, population, ED use effects, and other outcomes, with quality assessed using GRADE guidelines.

Main Results:

• Of 39 studies, patient education (2/5 studies) showed reductions from 21% to 80%, and patient financial incentives (9/10 studies) showed reductions from 3% to 50%.
• Managed care interventions (10/12 studies) also demonstrated decreases in ED use (1% to 46%).
• All studies had some risk of bias, with most rated as moderate, low, or very low quality.

Conclusions:

• Multiple interventions outside the ED show potential for reducing ED visits, with patient education and financial incentives yielding significant results.
• Managed care also emerged as an effective strategy for decreasing ED utilization.
• Findings offer insights for policymakers and insurers aiming to optimize healthcare resource allocation and reduce reliance on emergency departments.