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Reducing Emergency Department Utilization by Engaging Specialists

      The article by Jaffe et al
      • Jaffe T.A.
      • Kocher K.E.
      • Ghaferi A.A.
      Potentially avoidable emergency department use: when policy expects patients to be physicians.
      nicely describes the strategies at reducing avoidable emergency department (ED) visits. We believe that in addition to their proposed “provider-side” interventions, involvement of specialist clinicians is also crucial. Although the interventions described by the authors focus on ED and primary care practices, our US health care system continues to specialize (and subspecialize). As of 2015, 49% of physician office visits were to specialists, with approximately half of these visits related to routine and follow-up care and not to referrals or new patients.
      • Valderas J.M.
      • Starfield B.
      • Forrest C.B.
      • et al.
      Ambulatory care provided by office-based specialists in the United States.
      This suggests that specialists play a role in the ongoing and longitudinal care of certain patient populations. As a result, they may be able to affect ED use.
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      References

        • Jaffe T.A.
        • Kocher K.E.
        • Ghaferi A.A.
        Potentially avoidable emergency department use: when policy expects patients to be physicians.
        Ann Emerg Med. 2018; 72: 256-258
      1. National Ambulatory Medical Care Survey: 2015. Centers for Disease Control & Prevention, 2018
        • Valderas J.M.
        • Starfield B.
        • Forrest C.B.
        • et al.
        Ambulatory care provided by office-based specialists in the United States.
        Ann Fam Med. 2009; 7: 104-111
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        • Greenspan P.T.
        • Israel E.
        • et al.
        Emergency department utilization report to decrease visits by pediatric gastroenterology patients.
        Pediatrics. 2016; 138
        • Lee J.
        • Israel E.
        • Weinstein H.
        • et al.
        Using physician-level emergency department utilization reports to address avoidable visits by patients managed by pediatric specialists.
        Hosp Pediatr. 2017; 7: 686-691

      Linked Article

      • Potentially Avoidable Emergency Department Use: When Policy Expects Patients to be Physicians
        Annals of Emergency MedicineVol. 72Issue 3
        • Preview
          Identifying and preventing avoidable use of the emergency department (ED) may provide substantial cost savings. One study suggested approximately one fifth of US ED visit episode costs could be avoidable, with an annual estimated expense of greater than $60 billion.1 Considering the cost associated with ED use, payers have embarked on policies with the goal of reducing what is perceived as inappropriate ED visits. These strategies have put patients at greater financial risk and have faced scrutiny from the medical community.
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      • In reply:
        Annals of Emergency MedicineVol. 72Issue 6
        • Preview
          In the article titled “Potentially Avoidable Emergency Department Use: When Policy Expects Patients to Be Doctors,”1 we discussed the challenges of appropriately treating patients with acute care needs and the concerns with restricting access related to “potentially avoidable” emergency department (ED) use. We first described the current health policy context and then highlighted a promising strategy from a collaboration between payers and providers for bariatric surgery patients.
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