Program Name /
Summary of Findings
Frequent Users of the
Program to Improve
Care and Reduce
Emergency Room Utilization
The authors describe a case management program for frequent users
of the emergency department. The study had a single-subject design,
with evaluation for each patient of the number of visits to the
emergency department for a 12-month period before referral to the
program and a similar period after implementation of an
individualized care plan. Referrals were made on the basis of two or
more of the following criteria: chronic medical condition, complex
medical condition, drug-seeking behavior, violent behavior, and
abusive behavior. A multidisciplinary team developed the
individualized care plans. Twenty-four patients agreed to participate.
For the 12-month period before their referral, these patients
accounted for a total of 616 (median 26. 5) visits to the emergency
department; for a similar period after implementation of the care
plans, they accounted for 175 (median 6. 5) visits. The difficult-case
management program appeared to be effective in reducing the total
number of visits to the emergency department during the study
period and in improving the care for these patients.
Researchers at the Robert F. Wagner Graduate School of Public
Service of New York University explored the differences in health
outcomes experienced by low-income patients who received
primary care services in various health care settings in New York
City. Patients who do not receive appropriate primary care
frequently use emergency rooms for nonemergencies or they are
hospitalized for existing conditions that can be managed with routine
care. As part of their study, the investigators: ( 1) Examined about
200 million Medicaid claims records filed over a six-year period; ( 2)
Examined records from the New York City public hospital and
health care system; ( 3) Surveyed 300 primary care providers affiliated
with hospitals and other institutions; ( 4) Explored why some patients
choose to use emergency rooms for their primary care needs while
others seek care in outpatient settings.
Room Use by Low-Income Patients May
Improve Their Health
Skills Can Reduce
Visits of Children with
From 1997 to 2000, the University of Arizona College of Medicine
developed and tested a model program to train paramedics to treat
children with special health care needs at the scene instead of
transporting them to an emergency facility. At the time the grant was
made, such a training program did not exist. The model program
focused on needs including severe asthma, seizure disorders, and
cerebral palsy; children with those conditions may be dependent on
oxygen supplementation, infusion pumps, or other technology.
Investigators at the university's Arizona Emergency Medicine
Research Center (AEMRC) developed the program, which
paramedics could complete in a self-instruction course while on duty.
It included: ( 1) A self-study manual and companion video. ( 2) Eleven
integrated practice case scenarios. ( 3) A skills evaluation workshop.
( 4) A handbook of clinical activities with a supplemental CD.