Patient education results in the greatest magnitude reduction of unnecessary emergency department use, though more studies are published investigating the effect of patient financial incentives and managed care on reducing unnecessary ED use, according to a study published in Academic Emergency Medicine.
The study reviewed literature on five ED overutilization interventions: patient education, creation of additional non-ED capacity, managed care, prehospital diversion and patient financial incentives.
Two-thirds of the 39 included studies detailed successful interventions. While patient education reduced ED overutilization the most, financial incentives and managed care were more consistent in creating care utilization reductions, albeit in smaller magnitudes. Additional findings include:
- Patient education: Two of five studies found reductions between 21 and 80 percent.
- Additional non-ED capacity: Four of ten of studies showed reductions between 9 and 54 percent.
- Prehospital diversion: Two of two studies showed reductions between 3 and 7 percent.
- Managed Care: Ten of 12 studies showed reductions between 1 and 46 percent.
- Patient Financial Incentives: Nine of 10 studies found decreases between 3 and 50 percent.
The effect of each intervention on cost, quality outcomes and non-ED use was mixed, and data quality was lacking. Researchers indicated more must be done to create quality research on reducing unnecessary ED use.
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