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The Effectiveness of Emergency Department Visit Reduction Programs: A Systematic Review
Maria C Raven1, Margot Kushel2, Michelle J Ko3
1Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
Annals of Emergency Medicine
|June 12, 2016
Summary
High-quality evidence on emergency department (ED) visit reduction programs is limited. Case management was the only intervention consistently reducing ED visits without increasing adverse events.
Area of Science:
- Health Services Research
- Public Health
- Healthcare Management
Background:
- Previous reviews of emergency department (ED) visit reduction programs often included low-quality studies.
- A critical evaluation of program effectiveness and safety is needed.
Purpose of the Study:
- To systematically review the effectiveness of ED visit reduction programs.
- To determine if these programs lead to adverse events.
Main Methods:
- Systematic review of US-based studies (2003-2014) targeting adult patients.
- Quality assessment using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.
- Inclusion of moderate- to high-quality studies, categorizing interventions by target population (high-risk or low-acuity).
Main Results:
- 13 of 38 studies met quality criteria.
- Case management was the only intervention consistently reducing ED visits.
- ED copayment studies yielded mixed results.
- No increase in adverse events (hospitalization, mortality) was observed.
Conclusions:
- High-quality evidence on ED visit reduction programs is scarce.
- Definitive conclusions on the effectiveness of most program types could not be drawn.
- Future programs require rigorous evaluation as demonstrations.
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