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CE Connection

Frequent ED utilizers

A case management program to address patient needs

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doi: 10.1097/01.NUMA.0000471440.32173.39
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INSTRUCTIONS Frequent ED utilizers: A case management program to address patient needs


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Frequent ED utilizers: A case management program to address patient needs

GENERAL PURPOSE: To provide information about a hospital-based case management program to reduce avoidable ED visits. LEARNING OBJECTIVES: After completing this continuing-education activity, you should be able to: 1. Outline the purpose and design of the research described. 2. Identify the study's interventions and outcomes of significance.

  1. Primary care settings offer which advantage over ED visits?
    1. more personalized care
    2. more efficient use of resources
    3. more appropriate treatments
  2. Which criterion did the hospital use to identify patients as frequent utilizers?
    1. patients who cause staff burnout and ED overcrowding
    2. patients who are best served by episodic, acute care
    3. patients with a significant number of ED visits
  3. The initial ED case management program sought to
    1. improve the quality of care in the ED.
    2. increase alignment of frequent utilizers with a PCP.
    3. reduce the number of ED visits.
  4. Which criterion was required for patients to be considered for case management?
    1. at least 20 ED visits in the previous year
    2. vetting by a review committee
    3. referral by ED staff
  5. What's the goal of involving the patient in designing the care plan?
    1. to identify the barriers to receiving care in a less acute setting
    2. to motivate the patient to seek lower cost treatment
    3. to decrease the patient's motivation to seek care at the ED
  6. Inaccessibility of care plans in the medical record was addressed by
    1. migrating to a new EHR.
    2. consulting the compliance officer.
    3. instituting an ED information exchangesystem.
  7. Which step was taken to ensure HIPAA compliance for program evaluation by county researchers?
    1. approval by the clinical research manager
    2. review by the nursing governance research council
    3. implementation of a business associate agreement
  8. Which statement concerning older frequent utilizers is accurate?
    1. They had more preintervention ED visits than younger patients.
    2. They had fewer preintervention ED visits than younger patients.
    3. They had fewer postintervention ED visits than younger patients.
  9. Preintervention, the average number of visits for those with Medicaid coverage was
    1. significantly higher than for those without Medicaid.
    2. significantly lower than for those without Medicaid.
    3. approximately equal to those without Medicaid.
  10. What was learned about mental health issues in this patient group?
    1. More of the 22 patients had substance abuse codes than behavioral/mental health codes.
    2. A majority of the frequent utilizers were coded for mental health concerns.
    3. Behavioral/mental health issues aren't drivers of calling 911.
  11. Which chief complaint was found most frequently among the EDCMP participants?
    1. infection symptoms
    2. pain
    3. gastrointestinal symptoms
  12. Individualized case management was shown to
    1. improve the health of frequent utilizers.
    2. improve the quality of care in the ED.
    3. reduce the frequency of ED visits.
  13. Which statement related to the costs of the EDCMP is accurate?
    1. It averaged $12,000 per individual.
    2. Private insurance companies benefitted most with the highest overall cost savings.
    3. It will likely reduce overall costs of operating the ED.
  14. This study showed that ED staff frustration and burnout can be lessened by
    1. the option to refer patients to the EDCMP.
    2. patients who are content with their care.
    3. implementing morale-building activities.
  15. Regarding Medicaid-insured participants, the “ER is for Emergencies” initiative
    1. was determined not to be a confounding factor in this study.
    2. had less impact on reducing ED visits than the EDCMP.
    3. was developed by case management staff at this hospital to educate patients.
  16. Which recommendation would make data analysis easier for the researchers?
    1. expanding EHR program capabilities to allow for database queries
    2. coding each patient's data into a statistical program
    3. permitting researchers direct access to the EHR at each institution
  17. The outcomes evaluation plan for this program was
    1. devised as part of the initial research plan.
    2. ongoing during implementation of the program.
    3. conducted by an external agency.
  18. EMS personnel estimated that what percentage of frequent utilizers had chemical dependency or mental health problems?
    1. 5%
    2. 15%
    3. 25%
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