title: Cost-effective: emergency department care coordination with a regional hospital information system.
abstract: BACKGROUND
  Frequent and unnecessary utilization of the emergency department (ED) is often a sign of serious latent patient issues, and the associated costs are shared by many. Helping these patients get the care they need in the appropriate setting is difficult given their complexity, and their tendency to visit multiple EDs.
  
  
  OBJECTIVE
  We analyzed the cost-effectiveness of a multidisciplinary ED-care-coordination program with a regional hospital information system capable of sharing patients' individualized care plans with cooperating EDs.
  
  
  METHODS
  ED visits, treatment costs, cost per visit, and net income were assessed pre- and postenrollment in the program using nonparametric bootstrapping techniques. Individuals were categorized as frequent (3-11 ED visits in the 365 days preceding enrollment) or extreme (≥12 ED visits) users. Regression to the mean was tested using an adjusted measure of change.
  
  
  RESULTS
  Both frequent and extreme users experienced significant decreases in ED visits (5 and 15, respectively; 95% confidence intervals [CI] 2-5 and 13-17, respectively) and direct-treatment costs ($1285; 95% CI $492-$2364 and $6091; 95% CI $4298-$8998, respectively), leading to significant hospital cost savings and increased net income ($431; 95% CI $112-$878 and $1925; 95% CI $1093-$3159, respectively). The results further indicate that fewer resources were utilized per visit. Regression to the mean did not seem to be an issue.
  
  
  CONCLUSIONS
  When examined as a whole, research on the program suggests that expanding it would be an efficient allocation of hospital, and possibly societal, resources.
authors: Department of Health Policy and Administration, Washington State University, Spokane, Washington.
authors: Sean M
authors: SM
authors: Murphy
authors: Consistent Care Program, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington.
authors: Darin
authors: D
authors: Neven
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000191:economics / Q000517:prevention & control; D006751:Hospital Information Systems; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: care coordination; cost-effectiveness; emergency department; frequent users; information exchange