Emergency room (ED) capacity management has a wide range of effects on health and health system functions. Overcrowded Delay managementIncrease the patient mankindAnd connected Patient dissatisfaction.
meantime, Low utilization EDS can lead to waste, especially from health systems. short To the provider. In response portion The health system is a cost -containing strategy to reduce ED capacity. Veteran Business Department (VA) This practice has not been adopted, and it is important move Veterans are risk of leaving all VA systems for Veterans who use non -VA community Edcare. This led to the balloon. costs In the case of VA, it can have a negative impact on the veteran. health.
New study
recent paper Evidence -based policy resource center with partners (peprec) Evaluated the influence of VA ED’s ability to use veterans in community management (CC) EDS. Specifically, the authors evaluated whether the increased doctor’s ability to move the demand from CC ED or ultimately bring the veteran in -house.
Research methods and limitations
The author used more than 100 VA ED’s VA company data warehouse data from 2014 to 2019 to enrich the data with the US community survey and the socio -economic indicators of local health resources files. Independent variables were measured using the time required for the patient meeting for 8 hours in ED’s capacity. Clinic DayThe CC ED claim was a result variable.
This study used the tool variable approach. The two tools were the same equivalent ratio of federal holidays and emergency clinical clinic. This model has been adjusted for veteran population statistics, insurance coverage, socioeconomic factors and ED waiting time. Sensitive analysis confirmed that the results are powerful, and the tool variables have been validated with relevance and intensity.
It is noteworthy that the evaluation has been limited by dependence on claim data and how the ED capacity was evaluated by VA. The result is a lack of differentiation between veteran ED and emergency treatment, and we can’t tell you how certain resources were assigned to the clinic (eg, facility bed). Finally, the study period ended in 2019 and is not large. Operating change Since 2020. Overall, the evaluation results may not be generalized beyond the VA system.
result
This study shows that the use of CC ED services reduces the use of VA ED doctors. When the author used the ratio of the federal holiday as a tool, when they added 8 hours of clinical shift per 10,000 registrants, the CC ED claim decreased by 61 charges per month per 10,000 registrants. They found that when using the regular supervision of emergency clinical clinic as a device, the addition of an 8 -hour clinical shift per 10,000 registrants decreased 48 claims per 10,000 registrants per month.
Another method is that if the VA ED capacity increases by 1% using the vacation -based model, the CC ED claim decreased by 1.42%. Similarly, the CC ED claims decreased by 1.13% due to an increase of 1% by using the regular model of emergency clinical clinic.
Importantly, VA facilities with the lowest ED capacity were quite high in CC ED. On the contrary, VA facilities with the highest ED capacity were the lowest in CC ED. In short, this means that adding an 8 -hour clinic day to the lowest ED capacity has had the greatest effect on the use of veteran CC ED.
conclusion
These results have been confirmed that improving VA ED capacity can inhibit the dependence of CC ED. Similarly, maintaining more emergency treatment in -house is likely to increase the use of other VA services, just as many EDs occur. need Subsequent measures. Policy drafts provide a proven way to help integrate Veterans into VA systems by expanding VA ED capacity, considering various options to solve VA problems.
PEPREC is a team of health economists, public health researchers and policy analysts who support VA efforts to improve the lives of Veterans by using advanced quantum methods that are mostly funded by QUERI in the Veterans Health Bureau.
