A Systematic Review of Primary Care and Payment Models on Emergency Department Use in Patients Classified as High Need, High Cost

• Published in: Journal of emergency nursing Vol. 47; no. 5; pp. 761 - 777.e3
• Main Authors: Bilazarian, Ani, Hovsepian, Vaneh, Kueakomoldej, Supakorn, Poghosyan, Lusine
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2021; Elsevier Limited
• Subjects: Access; Adults; Avoidable; Chronic disease; Chronic illnesses; Clinical outcomes; Continuity of care; Coordination; Costs; Disease management; Emergency medical care; Emergency service; Emergency services; Health care expenditures; Health care management; Health care policy; Medicare; Multidisciplinary teams; Patients; Population; Population health; Primary care; Primary health care; Subject heading schemes; Systematic review; United States > US; Emergency service; Chronic disease; Primary health care; Population health
• ISSN: 0099-1767; 1527-2966; 1527-2966
• DOI: 10.1016/j.jen.2021.01.012

Reducing costly and harmful ED use by patients classified as high need, high cost is a priority across health care systems. The purpose of this systematic review was to evaluate the impact of various primary care and payment models on ED use and overall costs in patients classified as high need, high cost. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search was performed from January 2000 to March 2020 in 3 databases. Two reviewers independently appraised articles for quality. Studies were eligible if they evaluated models implemented in the primary care setting and in patients classified as high need, high cost in the United States. Outcomes included all-cause and preventable ED use and overall health care costs. In the 21 articles included, 4 models were evaluated: care coordination (n = 8), care management (n = 7), intensive primary care (n = 4), and alternative payment models (n = 2). Statistically significant reductions in all-cause ED use were reported in 10 studies through care coordination, alternative payment models, and intensive primary care. Significant reductions in overall costs were reported in 5 studies, and 1 reported a significant increase. Care management and care coordination models had mixed effects on ED use and overall costs. Studies that significantly reduced ED use had shared features, including frequent follow-up, multidisciplinary team-based care, enhanced access, and care coordination. Identifying primary care models that effectively enhance access to care and improve ongoing chronic disease management is imperative to reduce costly and harmful ED use in patients classified as high need, high cost.