Research from Philips and the George Washington University School of Medicine & Health Sciences reveals unsustainable emergency department (ED) use in seven developed nations. The paper, titled, “Acute unscheduled care in seven developed nations: a cross-country comparison,” compares the similarities and differences across nations with a focus on care delivery and the impact of socioeconomic factors. Countries evaluated for the report include: Canada, the U.S., the U.K., the Netherlands, Switzerland, Germany and Australia.
Better access to primary care can result in lower ED use
Combining public data with extensive, regional physician interviews, researchers from Philips and the GW School of Medicine & Health Sciences were able to highlight key insights from the seven countries studied. There’s a belief that easy access to primary care can result in lower emergency department use. However, as a result of this report, it is clear that even if people have easy access to primary care and full healthcare coverage, there is no guarantee the patients will make economically prudent decisions to seek the most appropriate medical care setting. More specifically, the findings of the report show Germany (22%) and Australia (22%) as having the lowest ED use, likely resulting from better (and faster) access to primary care—nearly two-thirds of Australians (58%) and threequarters of Germans (72%) were able to make same or next day appointments with their primary care physicians (PCPs) compared to less than half of Americans (48%) and Canadians (41%). In relation to readmissions, a metric used to determine the quality of care delivered, the U.S. showed the best performance for readmissions due to gaps in hospital or surgery discharge, discharge planning and transitional care. This, despite the fact it has the lowest compulsory insurance coverage. This could be attributed to the fact that the U.S. has instituted a number of programmes with payment incentives proven to be effective in improving care transitions and reducing hospital readmissions. As a result of the Patient Protection and Affordable Care Act, for example, U.S. hospitals are now facing financial penalties if patients are readmitted to a hospital.
Key areas for improvement
Taking the global data, researchers distilled their findings into a list of key areas impacting the way care is delivered in emergency settings. Making these observations actionable, researchers produced a list of the ten areas that cause these broad differences in available treatments, provider trainings and care quality across countries. Key takeaways include: social determinants (smoking, eating, violence, substance abuse and poverty) have a strong impact on the use of EDs; reduced access to health insurance results in poorer population health, placing a greater strain on emergency departments; sick patients do not make the most efficient decisions about when and where to seek medical care; extensive provider training is mandatory for effective delivery of acute unscheduled care; quality measures for EDs are immature and not standardized. “In looking at the way emergency departments are used around the world, we were able to obtain valuable new insights to help improve care delivery,” said Jesse Pines, MD, MBA, MSCE and Director of the GW Center for Healthcare Innovation and Policy Research at the GW School of Medicine & Health Sciences. “Because of research findings presented in this report, all emergency departments (no matter their location) have the opportunity to efficiently improve the way care is delivered in emergency department settings.”
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