title: In review of ED utilization reduction strategies, data regarding impact on safety, outcomes in short supply.
abstract: To gather insight on an array strategies used to curb ED utilization, investigators conducted a systematic review of five types of interventions that are based outside of the ED: patient education, patient financial incentives, the creation of additional non-ED capacity, pre-hospital diversion, and managed care. While the available evidence showed that all of the interventions had some impact on reducing ED utilization, researchers caution that there was scant data showing what impact these interventions had on outcomes or safety. Investigators found that patient education interventions were associated with the greatest magnitude of reductions in ED use, but they stress that the interventions reviewed were very heterogeneous. Interventions involving patient financial incentives primarily focused on putting financial barriers in place between patients and the ED. They were effective at reducing ED utilization, but investigators caution that policy makers need to consider the potential impact on outcomes. There was some evidence that creating additional non-ED capacity fueled demand for care, but had a small impact on ED utilization. Going forward, emergency providers need to fully engage in any discussions about ED utilization and demonstrate the value that EDs bring to the health care system, say experts.
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D014481:United States