Potentially Preventable Hospital and Emergency Department Events: Lessons from a Large Innovation Project

Leif I. Solberg, Kris A. Ohnsorg, Emily D. Parker, Robert Ferguson, Sanne Magnan, Robin R. Whitebird, Claire Neely, Emily Brandenfels, Mark D Williams, Mark Dreskin, Todd Hinnenkamp, Jeanette Y. Ziegenfuss

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION: There are few proven strategies to reduce the frequency of potentially preventable hospitalizations and Emergency Department (ED) visits. To facilitate strategy development, we documented these events among complex patients and the factors that contribute to them in a large care-improvement initiative. METHODS: Observational study with retrospective audits and selective interviews by the patients' care managers among 12 diverse medical groups in California, Minnesota, Pennsylvania, and Washington that participated in an initiative to implement collaborative care for patients with both depression and either uncontrolled diabetes, uncontrolled hypertension, or both. We reviewed information about 373 adult patients with the required conditions who belonged to these medical groups and had experienced 389 hospitalizations or ED visits during the 12-month study period from March 30, 2014, through March 29, 2015. The main outcome measures were potentially preventable hospitalizations or ED visit events. RESULTS: Of the studied events, 28% were considered to be potentially preventable (39% of ED visits and 14% of hospitalizations) and 4.6% of patients had 40% of events. Only type of insurance coverage; patient lack of resources, caretakers, or understanding of care; and inability to access clinic care were more frequent in those with potentially preventable events. Neither disease control nor ambulatory care-sensitive conditions were associated with potentially preventable events. CONCLUSION: Among these complex patients, patient characteristics, disease control, and the presence of ambulatory care-sensitive conditions were not associated with likelihood of ED visits or hospital admissions, including those considered to be potentially preventable. The current focus on using ambulatory care-sensitive conditions as a proxy for potentially preventable events needs further evaluation.

Original languageEnglish (US)
JournalThe Permanente journal
Volume22
DOIs
StatePublished - Jun 4 2018

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Hospital Departments
Hospital Emergency Service
Hospitalization
Ambulatory Care
Patient Care
Insurance Coverage
Proxy
Observational Studies
Outcome Assessment (Health Care)
Interviews
Hypertension

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Solberg, L. I., Ohnsorg, K. A., Parker, E. D., Ferguson, R., Magnan, S., Whitebird, R. R., ... Ziegenfuss, J. Y. (2018). Potentially Preventable Hospital and Emergency Department Events: Lessons from a Large Innovation Project. The Permanente journal, 22. https://doi.org/10.7812/TPP/17-102

Potentially Preventable Hospital and Emergency Department Events : Lessons from a Large Innovation Project. / Solberg, Leif I.; Ohnsorg, Kris A.; Parker, Emily D.; Ferguson, Robert; Magnan, Sanne; Whitebird, Robin R.; Neely, Claire; Brandenfels, Emily; Williams, Mark D; Dreskin, Mark; Hinnenkamp, Todd; Ziegenfuss, Jeanette Y.

In: The Permanente journal, Vol. 22, 04.06.2018.

Research output: Contribution to journalArticle

Solberg, LI, Ohnsorg, KA, Parker, ED, Ferguson, R, Magnan, S, Whitebird, RR, Neely, C, Brandenfels, E, Williams, MD, Dreskin, M, Hinnenkamp, T & Ziegenfuss, JY 2018, 'Potentially Preventable Hospital and Emergency Department Events: Lessons from a Large Innovation Project', The Permanente journal, vol. 22. https://doi.org/10.7812/TPP/17-102
Solberg, Leif I. ; Ohnsorg, Kris A. ; Parker, Emily D. ; Ferguson, Robert ; Magnan, Sanne ; Whitebird, Robin R. ; Neely, Claire ; Brandenfels, Emily ; Williams, Mark D ; Dreskin, Mark ; Hinnenkamp, Todd ; Ziegenfuss, Jeanette Y. / Potentially Preventable Hospital and Emergency Department Events : Lessons from a Large Innovation Project. In: The Permanente journal. 2018 ; Vol. 22.
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AU - Ferguson, Robert

AU - Magnan, Sanne

AU - Whitebird, Robin R.

AU - Neely, Claire

AU - Brandenfels, Emily

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AU - Dreskin, Mark

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N2 - INTRODUCTION: There are few proven strategies to reduce the frequency of potentially preventable hospitalizations and Emergency Department (ED) visits. To facilitate strategy development, we documented these events among complex patients and the factors that contribute to them in a large care-improvement initiative. METHODS: Observational study with retrospective audits and selective interviews by the patients' care managers among 12 diverse medical groups in California, Minnesota, Pennsylvania, and Washington that participated in an initiative to implement collaborative care for patients with both depression and either uncontrolled diabetes, uncontrolled hypertension, or both. We reviewed information about 373 adult patients with the required conditions who belonged to these medical groups and had experienced 389 hospitalizations or ED visits during the 12-month study period from March 30, 2014, through March 29, 2015. The main outcome measures were potentially preventable hospitalizations or ED visit events. RESULTS: Of the studied events, 28% were considered to be potentially preventable (39% of ED visits and 14% of hospitalizations) and 4.6% of patients had 40% of events. Only type of insurance coverage; patient lack of resources, caretakers, or understanding of care; and inability to access clinic care were more frequent in those with potentially preventable events. Neither disease control nor ambulatory care-sensitive conditions were associated with potentially preventable events. CONCLUSION: Among these complex patients, patient characteristics, disease control, and the presence of ambulatory care-sensitive conditions were not associated with likelihood of ED visits or hospital admissions, including those considered to be potentially preventable. The current focus on using ambulatory care-sensitive conditions as a proxy for potentially preventable events needs further evaluation.

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