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Preventing Emergency Department Visits for Children With Medical Complexity Through Ambulatory Care: A Systematic
Christian D Pulcini1, Ryan J Coller2, Amy J Houtrow3
1Division of Emergency Medicine, Department of Surgery, University of Vermont (CD Pulcini), Burlington, Vt.
Insights
Providing 24/7 access to knowledgeable providers via phone or offering expedited appointments can significantly reduce emergency department visits for children with medical complexity. These strategies improve care access and potentially lower healthcare costs.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Emergency Medicine
Background:
- Children with medical complexity (CMC) have high emergency department (ED) utilization.
- Strategies to reduce preventable ED visits for CMC are not well understood.
Purpose of the Study:
- To identify effective components of ambulatory care programs for CMC that prevent ED visits.
Main Methods:
- Systematic literature search of multiple databases (PubMed Plus, Cochrane, Web of Science, Scopus, CINAHL) up to October 2019.
- Inclusion of English language articles on CMC, emergency care, or ED utilization.
- Data extraction focused on ED utilization.
Main Results:
- Sixteen studies on outpatient interventions to prevent ED visits were identified.
- 24/7 telehealth access to knowledgeable providers and expedited/next-day appointments were most effective in reducing ED visits.
Conclusions:
- Real-time provider access and expedited appointments show promise in preventing ED visits for CMC.
- Further research is needed to generalize findings and explore novel strategies like telehealth for improved care and cost-effectiveness.
Background:
Children with medical complexity (CMC) represent a growing population with high emergency department (ED) utilization. How to reduce preventable ED visits is poorly understood.
Objective:
We sought to determine what components of ambulatory care programs focused on CMC were most effective in preventing ED visits.
Data Sources:
PubMed Plus, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases through October 2019, and hand search of bibliographies.
Study Eligibility Criteria:
Two independent reviewers used a structured screening protocol to include English language articles summarizing studies that included CMC, emergency care, or ED utilization. Data on ED utilization were extracted.
Results:
Sixteen included studies described outpatient interventions to prevent ED utilization. Of these, studies that included 24/7 access to knowledgeable providers for acute care needs by phone (telehealth) or expedited or next-day appointments were the most consistently successful in reducing ED visits.
Limitations:
Risk of bias was mixed across studies. The evidence base is currently small and observational nature of interventions and their evaluations limit definitive, generalizable recommendations.
Conclusions And Implications Of Key Findings:
Current research suggests that real-time access to knowledgeable providers and expedited appointments can prevent ED visits. Further study is needed to generalize these findings as well as investigate novel strategies such as telehealth to improve quality of care, decrease utilization, and provide cost-effective care for this vulnerable population.
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