Incorporating Alternative Care Site Characteristics Into Estimates of Substitutable ED Visits.

Area of Science:

• Health Services Research
• Healthcare Management
• Public Health

Background:

• Efforts to improve healthcare value often target reducing emergency department (ED) visits treatable at alternative care sites.
• Estimates of ED visit substitutability are sensitive to assumptions about alternative care site operating hours and capabilities.
• Existing methods lack ways to account for the variability in these alternative care site characteristics.

Purpose of the Study:

• To develop and present methods for incorporating variability in alternative care site characteristics into ED visit substitutability estimates.
• To provide a framework for more accurate assessments of healthcare resource utilization.

Main Methods:

• Developed "basic" and "extended" criteria to capture variations in alternative care site hours and functional capabilities.
• Applied these criteria to analyze 22,697 adult ED visits from the 2011 National Hospital Ambulatory Medical Care Survey.
• Defined a visit as substitutable if it was treat-and-release and met site-specific operating hours and capability criteria.

Main Results:

• The developed method established lower and upper bounds for ED visit substitutability across different alternative care settings.
• Primary care offices showed 5.5%-27.1% substitutability.
• Retail clinics demonstrated 7.6%-20.4% substitutability, while urgent care centers ranged from 10.6%-46.0%.

Conclusions:

• Alternative care sites exhibit significant variability in operating hours and functional capabilities.
• The proposed methodology can enhance the accuracy of estimating ED visit substitutability.
• This approach supports better resource allocation and healthcare value improvement strategies.