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Article Title

PreManage ED™ Evaluation in Hospitals of Alameda County, California

Publication Date

8-10-2017

Keywords

program evaluation, information technology, evaluation research, health care costs/resource use, hospitals, access to services, incentives in health care

Abstract

Background: In medically underserved markets, frequent utilization of the emergency department for nonurgent reasons suggests inadequate access to ambulatory care and contributes to suboptimal patient outcomes. Hospital-based interventions are challenging to implement because any single hospital has a limited view of a patient’s health story. To address this issue, PreManage ED™ (PMED), a data-sharing platform, has been implemented in 6 hospitals in Alameda County in Northern California –– 4 Sutter facilities and 2 Alameda Health System facilities. In the initial stage of the evaluation, we characterized PMED use and assessed user acceptance.

Methods: In this study, we defined the population to be anyone with at least one hospital visit to a PMED-participating Sutter facility in the past 30 days, and examined patient emergency department use from May 30, 2016, to August 28, 2016, at the 6 participating hospitals. Using PMED and electronic health record (EHR) data, we recorded application usage and measured volume of high utilizers (defined as 3+ encounters in 30 days at any of the participating facilities).

Results: During the study period, based on EHR, 47,455 patients made 49,453 encounters at the 4 Sutter Health emergency departments. PMED identified all encounters plus an additional 690 (1.4%) not found in the EHR. From these patients, PMED flagged 4,633 (10%) as high utilizers and identified 528 (11%) of these as having a care guideline in place at 1 of the 6 facilities. Among the 3 physicians, 2 case managers, 1 nurse and 4 other staff members who completed the questionnaire, at least 80% responded favorably to all questions concerning usefulness, at least 70% responded favorably to questions of ease of use, and at least 70% had a favorable attitude towards PMED.

Conclusion: Data indicate that PMED is successful at alerting providers to high utilizers in the emergency department, and there is no evidence that any were missed. Further, PMED was able to flag those with a care guideline in place at any facility, thus reducing the chance that extraneous care guidelines be created. Users had high rates of acceptance, which indicates a high chance of success for implementation of interventions relying on PMED.

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