The quality of treatment patients and populations get now heavily influenced by performance measurements. Payers and other stakeholders use the measurements to evaluate the effectiveness of the services they pay for and identify ways to make them better for patient health. HEDIS specifies six domains as crucial for assessing healthcare performance, with the efficacy of care being one of them. Even if the area covers a wide range of interventions, prevention is one of the most useful metrics for gauging the quality of care. To illustrate how treatment efficacy may influence and direct care quality, the study will concentrate on ED utilization (Capp et al., 2017). Utilization of emergency departments (EDs) accounts for a sizable portion of US medical spending. Despite reductions in active or functioning EDs, rises in US ED visits over the previous three decades have been reported. A 2010 study found that roughly 1 in 5 visits may have been avoided, costing the growing expense of healthcare and overcrowding in emergency rooms $65 billion. The average expense of treating basic primary care curable diseases at a hospital emergency department is 12 times more expensive than going to a doctor’s office and 10 times more expensive than going to an urgent care facility for assistance with the same problems.
Access to primary care, the identification of mental health issues, the lack of care coordination, the lack of empowerment to self-manage chronic diseases, and socioeconomic determinants of health (SDOH) are some of the variables that lead patients to need emergency department services. Visiting the emergency room requires a lot of engagement and costs money for both the patient and the healthcare system. Numerous healthcare organizations have made reducing needless ED usage a priority and have created initiatives in collaboration with physicians (Enard & Ganelin, 2013).
Patient Education and self-management support
The educational interventions, including informational booklets, monthly group sessions with educational elements, teaching patients how to navigate the medical system, and offering advice in emotional and social challenges have a significant effect on ED use. When educational interventions are used independently, with the only goal of educating patients about general health service consumption, they do not seem to be very effective. The fact that a standalone educational intervention does not statistically produce noticeable benefits in ED is concerning. When used as a component of a multidimensional approach, educational interventions appear to be more beneficial.
ED Utilization and Technology
To solve cost savings and prevent pointless visits, practitioners and care teams must comprehend why, when, as well as how patients contact the ED. It is difficult to keep track of patient trips to the ED given the many factors that might affect them, including sickness, access to treatment, patient understanding and decision-making, and lines of communication between institutions and providers. Monitoring ED use involves technology to a considerable extent. Providers have been helped, in particular to make more exact care management decisions through telemedicine and care coordination. With the current pandemic, telemedicine has become a tool that is frequently used by healthcare professionals. In addition to giving the PCP the chance to inform the patient whether another level of treatment is necessary, a patient might be more inclined to make a telemedicine visit than to visit the ED. Therefore, telehealth has the potential to enhance and strengthen the patient-physician interaction. All stakeholders engaged in the patient’s care must cooperate and work together to provide coordinated care, and information sharing is essential. Patient portals and integrated health records provide technological assistance for this.
Coordination of Care
The most well-known strategy for reducing Emergency room visits through better coordination is case management. The goal of an interdisciplinary approach to personalized care planning is to support patients during their treatment process, which frequently crosses traditional care borders between community and hospital care. The strategy is based on a comprehensive examination. Case management might decrease ED visits, but further research is required to pinpoint the exact components of case management that are the most efficient and beneficial in terms of costs. The use of “nurse-led,” “evidence-based,” and “inter-professional” case-management strategies all increase their effectiveness. The accessibility of psychological services, the frequency of follow-up, as well as the aggressiveness of contact appear to be correlated with better outcomes in general, as do the depth of resources and the intensity of the intervention.
Improved Patient Outcomes
In addition to improving healthcare outcomes, primary care interventions are also more economical since they lessen the need for unnecessary preventative treatment. For the patient outcomes to develop, the aforementioned interventions must be put into practice. Having access to high-quality medical treatment will give patients more confidence. They have faith in their existing healthcare providers as a result. Patient satisfaction and cost savings are two important patient outcomes that may be attained through these strategies.
The best part is that the majority of the waste generated by emergency department visits can be prevented. Emergency department visits cost the healthcare business a tremendous amount of trash. Employers may greatly minimize unnecessary visits and save tens of millions of dollars annually by adopting the crucial actions: evaluating data, implementing staff education initiatives, and recognizing use trends. Finding these important savings possibilities is crucial right now, when every dollar matters (David et al., 2015).
The importance of follow-up treatment after ED visits cannot be overstated in terms of enhancing patient care, enhancing patient outcomes ratings, and possibly reducing future ED visits. In follow-up care, patient engagement measures are essential, and motivational interviewing techniques can help patients comprehend and be more conscious of their condition. Interactions at all stages of care can assist promote trips to the PCP instead of the ED through improved practice culture and procedures. Interacting with the patient after the ED visit can significantly strengthen understanding of the reason the patient visited the ED, therefore provide a chance to evaluate the patient’s comprehension of their treatment and release guidelines, evaluate medication compliance, evaluate risk factors for SDOH, and give the patient an educational opportunity.
Their assessment is hampered by the large variety of interventions, techniques, and populations utilized to quantify results. The majority of programs that aim to reduce ED usage have shown mixed outcomes. As a result, lowering ED usage will necessitate a comprehensive strategy that incorporates several interventions within the nation’s healthcare system and financial structure. It would be necessary to compare healthcare systems around the globe in order to comprehend the effects of the various characteristics (Moreno et al., 2021). However, it is reasonable to spend money on case-management techniques to enhance care coordination and reduce ED visits. In any scenario, a feedback system is necessary for any intervention in order to track results and unintended repercussions. For instance, expanding access sites for urgent treatment might reveal latent demand. One of the most crucial areas for determining the quality of care is its efficacy. All members of the healthcare team, insurers, and patients must work together continuously and communicate across the continuum of care to address ED use and other elements of health care.
Capp, R., Misky, G. J., Lindrooth, R. C., Honigman, B., Logan, H., Hardy, R., … & Wiler, J. L. (2017). Coordination program reduced acute care use and increased primary care visits among frequent emergency care users. Health Affairs, 36(10), 1705-1711.
David, G., Gunnarsson, C., Saynisch, P. A., Chawla, R., & Nigam, S. (2015). Do patient‐centered medical homes reduce emergency department visits? Health services research, 50(2), 418-439.
Enard, K. R., & Ganelin, D. M. (2013). Reducing preventable emergency department utilization and costs by using community health workers as patient navigators. Journal of Healthcare Management/American College of Healthcare Executives, 58(6), 412.
Moreno, G., Fu, J. Y., Chon, J. S., Bell, D. S., Grotts, J., Tseng, C. H., … & Mangione, C. M. (2021). Reducing Emergency Department Visits Among Patients With Diabetes by Embedding Clinical Pharmacists in the Primary Care Teams. Medical care, 59(4), 348-353.