The Checkpoint Program: collaborative care to reduce the reliance of frequent presenters on ED

Baird, Christine, Oytam, Yalchin, Rahman, Khairunnessa, Fornasari, Marja, Sharma, Anita, Kim, Jinman, Ahn, Euijoon, and Hughes, Rod (2021) The Checkpoint Program: collaborative care to reduce the reliance of frequent presenters on ED. International Journal of Integrated Care, 21 (2). 29.

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Abstract

Introduction: Growing pressures upon Emergency Departments [ED] call for new ways of working with frequent presenters who, although small in number, place extensive demands on services, to say nothing of the costs and consequences for the patients themselves. EDs are often poorly equipped to address the multi-dimensional nature of patient need and the complex circumstances surrounding repeated presentation. Employing a model of intensive short-term community-based case management, the Checkpoint program sought to improve care coordination for this patient group, thereby reducing their reliance on ED.

Method: This study employed a single group interrupted time series design, evaluating patient engagement with the program and year-on-year individual differences in the number of ED visits pre and post enrolment. Associated savings were also estimated.

Results: Prior to intervention, there were two dominant modes in the ED presentation trends of patients. One group had a steady pattern with ≥7 presentations in each of the last four years. The other group had an increasing trend in presentations, peaking in the 12 months immediately preceding enrolment. Following the intervention, both groups demonstrated two consecutive year-on-year reductions. By the second year, and from an overall peak of 22.5 presentations per patient per annum, there was a 53% reduction in presentations. This yielded approximate savings of $7100 per patient.

Discussion: Efforts to improve care coordination, when combined with proactive case management in the community, can impact positively on ED re-presentation rates, provided they are concerted, sufficiently intensive and embed the principles of integration.

Conclusion: The Checkpoint program demonstrated sufficient promise to warrant further exploration of its sustainability. However, health services have yet to determine the ideal organisational structures and funding arrangements to support such initiative

Item ID: 72028
Item Type: Article (Research - C1)
ISSN: 1568-4156
Copyright Information: © 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/. International Journal of Integrated Care is a peer-reviewed open access journal published by Ubiquity Press.
Date Deposited: 23 Feb 2022 01:36
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420308 Health informatics and information systems @ 100%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200199 Clinical health not elsewhere classified @ 100%
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