Health Research & Educational Trust of New Jersey (HRET)
Research
Ongoing Projects:
Reducing Inappropriate ED Use: Community Partnership for ED Express Care and Case Management
NEW!
September 23, 2008 Frequently Asked Questions (.pdf file size 34KB, 2pgs.)
HRET is working in partnership with the New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS), and the New Jersey Primary Care Association (NJPCA) to address the issue of inappropriate use of the emergency department (ED) for primary care services – care that would be provided more efficiently in a medical home.
HRET, NJPCA and DMAHS have designed a demonstration model for providing alternate non-emergency services to patients who present with primary care needs in hospital emergency departments, as well as patient education and support services to encourage the use of appropriate sites of care. This model is being pilot tested in two sites with the support of the Centers for Medicare and Medicaid Services, in fulfillment of subsection 1903(y) of the federal Deficit Reduction Act of 2005. This pilot project primarily targets Medicaid patients, but its ultimate goal is to provide care to all New Jersey residents in the most appropriate, efficient and cost-effective site.
The project’s two pilot sites are each implemented through a partnership of a hospital and federally qualified health center (FQHC), selected based on location in a county with high rate of ED use by Medicaid beneficiaries and certain demographic characteristics. The project model includes:
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Triage by an advanced practice nurse (APN) per EMTALA requirements;
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ED Express Care by the APN, including primary care services and prescriptions;
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Appointment set-up for primary care follow-up with the participating FQHC via Web-based system;
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Expansion of FQHC hours and staff to accommodate follow-up and walk-ins;
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Patient transportation to primary care visits, if needed;
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Education on the importance of a medical home and limiting ED visits to true emergency situations;
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Case management, outreach to frequent users and assistance with resolving barriers; and,
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Extensive monitoring of the model performance, tracking of barriers and devising strategies to improve the model, employing evaluation methodologies and assessment techniques.
HRET and NJPCA work with hospital and FQHC sites to support pilot implementation and collect project process and outcomes data. HRET, in close collaboration with NJPCA and the state’s Medicaid program, will use the collected data to measure the overall success of the pilot. Anticipated outcomes include a decline in hospital ED use for primary care services; increased capacity of the primary healthcare delivery system; greater use of community clinics and medical homes; improved routine access to preventive and primary care services; improved patient help-seeking behavior; increased patient satisfaction; significant short- and long-term cost savings for Medicaid; and, ultimately, a more efficient healthcare delivery system that is responsive to individual needs of diverse patients, better quality of care and healthier communities.