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Office "Phone First" Systems Reduce Emergency Department/Urgent Care Utilization by Medicaid-Enrolled Children
Steven Poole1, Erin Ambardekar2, Brian Gablehouse3
1Children's Hospital Colorado (S Poole, T Hegarty, C Armon, B Schmitt, and J Todd), Aurora, Colo; University of Colorado (S Poole, C Peters, M Lamb, B Schmitt, and J Todd), Aurora, Colo.
Insights
Implementing "Phone First" services in pediatric practices significantly reduced emergency department and urgent care visits for children. This initiative also lowered healthcare costs for Medicaid-enrolled children.
Area of Science:
- Pediatric healthcare quality improvement
- Health services research
- Cost-effectiveness analysis
Background:
- Emergency department and urgent care (ED/UC) visits for common pediatric conditions are often more costly and offer less continuity of care than primary care physician office visits.
- Primary care settings can improve pediatric care delivery and reduce costs through enhanced accessibility and proactive management.
Purpose of the Study:
- To evaluate the impact of enhanced "Phone First" telephone triage services on ED/UC utilization and associated costs in pediatric practices.
- To determine if quality improvement strategies in primary care can reduce reliance on more expensive acute care settings.
Main Methods:
- Quality-improvement methods were used to implement "Phone First" services, including enhanced office-hours triage, same-day appointments, follow-up calls for ED/UC referrals, and parent education.
- A four-year study (2014-2017) compared ED/UC encounter rates between intervention and regional control practices using general linear models.
- Balancing measures, including phone calls and visits, were evaluated for Medicaid-enrolled and commercially-insured children.
Main Results:
- Pediatric practices significantly increased office-hours acute care phone triage and advice.
- ED/UC rates decreased by 23.8% to 80.5% for Medicaid-enrolled children (P < 0.001), with modest decreases in office acute care visits.
- No decrease in ED/UC visits was observed in the comparison region; 94% of parents were satisfied with follow-up calls, and significant cost savings were estimated.
Conclusions:
- "Phone First" services during office hours effectively reduced ED/UC encounters for pediatric patients.
- These enhanced primary care services led to substantial cost savings for Medicaid-enrolled children, demonstrating a successful healthcare quality improvement strategy.
Background:
Emergency department and urgent care (ED/UC) visits for common conditions can be more expensive with less continuity than office care provided by primary care physicians.
Methods:
We used quality-improvement methods to enhance telephone triage for pediatric patients by adding additional "Phone First" services including: 1) enhanced office-hours telephone triage and advice with available same-day appointments, 2) follow-up calls to parents of children self-referred to an ED/UC, and 3) parent education to telephone the office for advice prior to seeking acute care. We hypothesized that enhanced office services would reduce ED/UC utilization and cost. We compared changes in ED/UC encounter rates between intervention and regional practices for 4 years (2014-2017) using general linear models, and evaluated balancing measures (after-hour phone calls, acute care phone calls, acute care visits, well child visits) for Medicaid-enrolled and commercially-insured children.
Results:
The study practices dramatically increased office-hours acute care phone triage and advice which correlated with 23.8% to 80.5% (P < 0.001) reductions in ED/UC rates for Medicaid-enrolled children. Office acute care visits decreased modestly. ED/UC visits did not decrease for children in the comparison region. In phone surveys, 94% of parents indicated satisfaction with the ED/UC follow-up call. The decrease in ED/UC visits resulted in an estimated annual cost of care savings for Medicaid-enrolled children in 2017 of $12.61 per member per month which projected to $169 million cost of care savings in Colorado and $6.8 billion in the United States.
Conclusion:
"Phone First" services in pediatric practices during office-hours reduced ED/UC encounters and cost of care for Medicaid-enrolled children.
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