AURORA, Colo. – Researchers at the University
of Colorado Anschutz Medical Campus have found that a
community-based program aimed at high users of hospital emergency departments
(EDs), reduced ED visits and hospital admissions, while increasing use of
primary care providers.
“Many programs have tried to tackle the problem of
high utilizers of hospital emergency departments. These are usually people who
are on Medicaid,” said the study’s first author Roberta Capp, MD, an assistant
professor of emergency medicine at the University
of Colorado School of Medicine. “But
this is the first program to show that care coordination actually works.”
The study was published October 2, 2017 in the journal
Health Affairs http://bit.ly/2fJUIaq.
Capp and her fellow researchers implemented and evaluated
Bridges to Care (B2C), an ED-initiated, community-based program. It was one of
four sites funded by a Center for Medicare and Medicaid Innovations grant.
The program was led by Rutgers University Center for
State Health Policy and developed in collaboration with four Colorado
stakeholders including an urban academic hospital, a network of 13 local
federally qualified health centers, a mental health clinic and a community
Researchers compared participants in the B2C program, which
focused on Medicaid eligible high ED users, with patients who had received
standard care with respect to ED utilization, hospital admission and primary
High ED users were identified as adults who had two or
more ED visits or hospital admissions within the last 180 days.
During the six months after B2C enrollment, the
participants had 29.7 percent fewer ED visits and 30 percent less
hospitalizations. At the same time, they had 123 percent more primary care
visits than the control subjects.
“There is a perspective from multiple
stakeholders that high users of the ED are difficult patients,” Capp said. “But
this study shows that patients use the ED because of there are serious barriers
ED care makes up 5 – 6 percent of all healthcare
Previous studies have shown that providing
care-coordination services and better access to primary care can reduce waste
in healthcare spending. A number of programs addressing low-income, high users
of EDs have been implemented with mixed results. Most were hospital-based with
little community involvement.
But Capp said the B2C intervention is the first aimed
at high users of EDs to combine active outreach in the ED with
multidisciplinary, community-based services.
It offers intensive medical, behavioral health and
social care coordination services. That includes providing a care coordinator,
a health coach, a behavioral health specialist, a community health worker and
frequent home visits.
Each patient was given a personally tailored, 60-day
care plan that included, but was not limited to assistance with getting housing
resources, refugee services, access to transportation, help with applying for
insurance and disability benefits, setting up primary and specialty care and
“We believe that our success stems from bringing
together different healthcare systems, breaking down silos between disciplines
and focusing on continuity of care in the outpatient setting,” Capp said.
The study shows just how intense the services offered
to this population must be to reduce their reliance on EDs. One reason is that
they often have chronic diseases, including mental illness.
“We learned that active outreach in the ED is key to
ensuring successful high utilizer and enrollment and engagement,” the study
For example, early in the study, the team used call
back lists and enrolled only 80 patients in seven to eight months, but when a
community health worker was embedded in the ED, enrollment over the same period
of time tripled.
“For a program like B2C to be effective, behavioral
health services must be provided to high utilizers to ensure comprehensive,
multidisciplinary care,” Capp said.
She hopes federal lawmakers examining the Affordable
Care Act will evaluate the program as a more cost efficient way of providing
high quality care to the most vulnerable.
Co-authors of the study from CU Anschutz include
Benjamin Honigman, MD, professor of emergency medicine; Jennifer Wiler, MD,
associate professor of emergency medicine and Richard Lindrooth, PhD, professor
in the department of health systems, management and policy.