Cost-effective: emergency department care coordination with a regional hospital information system.
BACKGROUND
Frequent and unnecessary utilization of the emergency department (ED) is often a sign of serious latent patient issues, and the associated costs are shared by many. Helping these patients get the care they need in the appropriate setting is difficult given their complexity, and their tendency to visit multiple EDs.


STUDY OBJECTIVE
We analyzed the cost-effectiveness of a multidisciplinary ED-care-coordination program with a regional hospital information system capable of sharing patients' individualized care plans with cooperating EDs.


METHODS
ED visits, treatment costs, cost per visit, and net income were assessed pre- and postenrollment in the program using nonparametric bootstrapping techniques. Individuals were categorized as frequent (3-11 ED visits in the 365 days preceding enrollment) or extreme (≥12 ED visits) users. Regression to the mean was tested using an adjusted measure of change.


RESULTS
Both frequent and extreme users experienced significant decreases in ED visits (5 and 15, respectively; 95% confidence intervals [CI] 2-5 and 13-17, respectively) and direct-treatment costs ($1285; 95% CI $492-$2364 and $6091; 95% CI $4298-$8998, respectively), leading to significant hospital cost savings and increased net income ($431; 95% CI $112-$878 and $1925; 95% CI $1093-$3159, respectively). The results further indicate that fewer resources were utilized per visit. Regression to the mean did not seem to be an issue.


CONCLUSIONS
When examined as a whole, research on the program suggests that expanding it would be an efficient allocation of hospital, and possibly societal, resources.
['Murphy|Sean M|SM|', 'Neven|Darin|D|']
D000328:Adult D000368:Aged D003362:Cost-Benefit Analysis D004636:Emergency Service, Hospital D005260:Female D017048:Health Care Costs D006300:Health Services Misuse D006751:Hospital Information Systems D006801:Humans D007182:Income D008297:Male D008875:Middle Aged D012189:Retrospective Studies D055815:Young Adult
cost-effectiveness emergency department care coordination frequent users information exchange