The study was conducted in University Hospital, USA. This study aimed to identify potential strategies aimed at preventing unnecessary returns to the ED following bariatric surgery. Abbreviations: DD, difference‐in‐differences ED, emergency department.Unnecessary emergency department (ED) visits following bariatric surgery represent a significant source of inefficient resource utilization. To provide context on the breakdown of visits at baseline, primary care substitutable visits accounted for 42% of all ED visits, potentially primary care preventable visits accounted for 25%, and injuries + other visits accounted for the remaining 33%. “Injuries + other” visits refer to the injury, alcohol, drug, psych, and unclassified categories of the algorithm. Potentially primary care preventable visits refer to the “emergent, preventable” and the “emergent, not preventable” categories of the algorithm. Primary care substitutable visits refer to the “non‐emergent” and “emergent, primary care treatable” categories of the New York University Emergency Department Algorithm. Notes: This bar graph shows the share of the estimated reduction in all‐cause ED visits that each category contributes to, based on the DD estimates. Our results suggest that greater access to the practice and more effective primary care both contributed to the lower growth in ED and UCC visits during the initiative.Įmergency departments Medicare savings programs access to care health care reform potentially avoidable visits potentially preventable visits primary care urgent care centers utilization.Įstimated share of the lower growth in the all‐cause Emergency Department visit rate, by emergency department category. UCC visits had 9% lower growth for both all-cause (P =. As expected, our falsification test showed no difference in ED visits for injuries. 04) lower growth in PPC preventable ED visits with no weekday/nonweekday differential. 02) lower growth in PC substitutable ED visits, driven by lower growth in weekday PC substitutable visits (4%, P =. 06) lower growth in all-cause ED visits than comparison practices. Both groups of practices had similar growth in ED and UCC visits in the two-year period before CPC.Ĭomprehensive Primary Care practices had 2% (P =. We used a propensity score-matched comparison group of practices that were similar to CPC practices before CPC on multiple dimensions. Our key outcomes were all-cause and primary care substitutable (PC substitutable) outpatient ED and UCC visits, and potentially primary care preventable (PPC preventable) ED visits, categorized by the New York University Emergency Department Algorithm. Regression models controlled for baseline practice and patient characteristics and practice-level clustering of standard errors. We used an adjusted difference-in-differences framework to test the association between CPC and beneficiaries' ED and UCC use from October 2012 through December 2016. Medicare claims data capturing characteristics and outcomes of 565 674 Medicare fee-for-service (FFS) beneficiaries attributed to 497 CPC practices and 1 165 284 beneficiaries attributed to 908 comparison practices. To determine the association between a large-scale, multi-payer primary care redesign-the Comprehensive Primary Care (CPC) Initiative-on outpatient emergency department (ED) and urgent care center (UCC) use and to identify the types of visits that drive the overall trends observed.
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