Can Patients Be Taught to Avoid Unnecessary Trips to the ER? A Study in AJMC® Suggests Some Can

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Efforts to cut down on unnecessary trips to the emergency room can take many forms. A new study by Kaiser Permanente, appearing in The American Journal of Managed Care®, suggests that the best education tools may vary depending on the patient’s age.

Unnecessary trips to the emergency room (ER) are a recognized cost driver in healthcare, but not everyone agrees on how to prevent them. Health plans have tried higher co-payments, and Anthem has taken the controversial step of refusing to pay for ER care if it later determines that a visit based on potentially serious symptoms turned out not to be.

Kaiser Permanente, meanwhile, has a study appearing in The American Journal of Managed Care® (AJMC®) that examines a more common problem: how to find patients who sought low-acuity ER care and teach them to seek ambulatory care for similar symptoms the next time.

Researchers speculated that patients might have different responses to education strategies, depending on their age. Across six ERs in the Kaiser Permanente Health Network, they identified a total of 9,093 patients who had made a low-acuity emergency visit; of these, 609 patients would receive a phone call and 771 would receive educational materials in the mail to tell them about other venues for their future medical needs. Patients were matched with controls, and researchers looked at ER use six months later.

They found that patients age 65 or older had a 22 percent drop in use of the ER after the phone call follow-up from an ER physician, while those younger than 65 had a 27 percent reduction after receiving educational materials in the mail. They agree that these differences call for more study: older patients appeared easier to reach by phone, for example.

Dr. Pankaj Patel, emergency physician at Kaiser Permanente Roseville/Sacramento Medical Center and lead author on the study, said his research team had anticipated these results. “We were pleased to find that our patients were so responsive to such simple interventions. A three-minute phone call from an emergency physician or a one-page information letter appeared to be effective ways to educate our patients about the multiple venues of care that were available. With that knowledge, patients could choose which setting best fit their future low-acuity medical care needs, not just the ER. We hope that our findings motivate others to utilize physician-directed education to give patients their healthcare access options.”


Accompanying the study is an editorial by Dr. Adam Sharp, of Kaiser Permanente Southern California and Dr. Mark Fendrick of the University of Michigan, who is co-editor in chief of AJMC®. Sharp and Fendrick ask the question: who gets to decide whether unscheduled acute care is “appropriate” or not? In most cases, they note, the patient must ultimately decide whether to go to the ER, and where is the value if they are thinking about a possibly large financial penalty instead of where they will get the best quality care?

“Consumers must not be left on their own to decide whether acute care is necessary and where it should be provided. Patient-centered approaches to optimize the use of the [emergency department] must be integrated into more comprehensive population health initiatives,” they write. “A key element of this strategic plan includes the development of user-friendly tools that help patients decide when to seek care and where best to receive it.”

About The American Journal of Managed Care®:

The American Journal of Managed Care® (AJMC®) is a peer-reviewed, MEDLINE-indexed journal that keeps readers on the forefront of health policy by publishing research relevant to industry decision makers as they work to promote the efficient delivery of high-quality care. is the essential website for managed care professionals, distributing industry updates daily to leading stakeholders. Other titles in the AJMC® family include The American Journal of Accountable Care®, and two evidence-based series, Evidence-Based Oncologyand Evidence-Based Diabetes Management. These comprehensive offerings bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. To order reprints of articles appearing in AJMC® publications, please contact Jeff Prescott at 609-716-7777, ext. 331.


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Surabhi Verma