TY - JOUR
T1 - Incorporating Alternative Care Site Characteristics Into Estimates of Substitutable ED Visits
AU - Seth Trueger, Nathan
AU - Chua, Kao Ping
AU - Hussain, Aamir
AU - Liferidge, Aisha T.
AU - Pitts, Stephen R.
AU - Pines, Jesse M.
N1 - Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017
Y1 - 2017
N2 - Background: Several recent efforts to improve health care value have focused on reducing emergency department (ED) visits that potentially could be treated in alternative care sites (ie, primary care offices, retail clinics, and urgent care centers). Estimates of the number of these visits may depend on assumptions regarding the operating hours and functional capabilities of alternative care sites. However, methods to account for the variability in these characteristics have not been developed. Objective: To develop methods to incorporate the variability in alternative care site characteristics into estimates of ED visit "substitutability." Research Design, Subjects, and Measures: Our approach uses the range of hours and capabilities among alternative care sites to estimate lower and upper bounds of ED visit substitutability. We constructed "basic" and "extended" criteria that captured the plausible degree of variation in each site's hours and capabilities. To illustrate our approach, we analyzed data from 22,697 ED visits by adults in the 2011 National Hospital Ambulatory Medical Care Survey, defining a visit as substitutable if it was treat-and-release and met both the operating hours and functional capabilities criteria. Results: Use of the combined basic hours/basic capabilities criteria and extended hours/extended capabilities generated lower and upper bounds of estimates. Our criteria classified 5.5%-27.1%, 7.6%-20.4%, and 10.6%-46.0% of visits as substitutable in primary care offices, retail clinics, and urgent care centers, respectively. Conclusions: Alternative care sites vary widely in operating hours and functional capabilities. Methods such as ours may help incorporate this variability into estimates of ED visit substitutability.
AB - Background: Several recent efforts to improve health care value have focused on reducing emergency department (ED) visits that potentially could be treated in alternative care sites (ie, primary care offices, retail clinics, and urgent care centers). Estimates of the number of these visits may depend on assumptions regarding the operating hours and functional capabilities of alternative care sites. However, methods to account for the variability in these characteristics have not been developed. Objective: To develop methods to incorporate the variability in alternative care site characteristics into estimates of ED visit "substitutability." Research Design, Subjects, and Measures: Our approach uses the range of hours and capabilities among alternative care sites to estimate lower and upper bounds of ED visit substitutability. We constructed "basic" and "extended" criteria that captured the plausible degree of variation in each site's hours and capabilities. To illustrate our approach, we analyzed data from 22,697 ED visits by adults in the 2011 National Hospital Ambulatory Medical Care Survey, defining a visit as substitutable if it was treat-and-release and met both the operating hours and functional capabilities criteria. Results: Use of the combined basic hours/basic capabilities criteria and extended hours/extended capabilities generated lower and upper bounds of estimates. Our criteria classified 5.5%-27.1%, 7.6%-20.4%, and 10.6%-46.0% of visits as substitutable in primary care offices, retail clinics, and urgent care centers, respectively. Conclusions: Alternative care sites vary widely in operating hours and functional capabilities. Methods such as ours may help incorporate this variability into estimates of ED visit substitutability.
KW - Emergency Department Utilization
KW - acute unscheduled care delivery
KW - health services research
UR - http://www.scopus.com/inward/record.url?scp=85021380179&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85021380179&partnerID=8YFLogxK
U2 - 10.1097/MLR.0000000000000733
DO - 10.1097/MLR.0000000000000733
M3 - Article
C2 - 28498199
AN - SCOPUS:85021380179
SN - 0025-7079
VL - 55
SP - 693
EP - 697
JO - Medical care
JF - Medical care
IS - 7
ER -