It’s well understood that patients who persistently seek routine care in the emergency department (ED) generate higher health care costs. But a closer look can also tell us something about how certain patients receive care through normal channels—or not. With access to data from claims and clinical sources, the Partners HealthCare Population Health and Data and Analytics teams are working together to shed light on the dynamics behind so-called ED overuse.

“We know that a subset of patients uses the Emergency Department (ED) for non-urgent issues instead of going to their primary care physician. This can lead to fragmented care as well as higher health care costs. I thought, ‘What if we could identify the most frequent utilizers of the Emergency Department and work to uncover why they are turning to the ED for care?’” explains Lara Terry, MD, Medical Director of Clinical Analytics and Informatics for Partners Population Health and a geriatrician at McLean Hospital.

Using the system-wide data, Partners clinicians can “hotspot” which patients can potentially benefit from timely interventions that could prevent an unnecessary ED visit. The tool is being used to identify groups of patients, or “phenotypes,” who are potentially in crisis, who have unmet needs that fall under specific diagnoses, or who could benefit from access to care after-hours or through triage. Clinicians can then connect these patients with high-risk care management programs, behavioral health supports, or in-home care programs—and hopefully anticipate and meet their needs before an ED visit happens.

“We are trying to understand in greater detail why certain patients use the emergency department so much,” says Jason Wasfy, MD, MPhil, Medical Director for Population Health Management at the Massachusetts General Physicians Organization. “With this information, we can develop creative clinical programs that meet the needs of these patients while also reducing preventable health care costs.”

More on the data-driven initiative here.

Topics: Integrated Care, Patient Experience, Access to Care

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