Health Policy and Health Services Research
Background: With population health and the growth of accountable care organizations (ACOs), there is an increased focus on home care options for patients discharged from the Emergency Department (ED). The purpose of this study was to describe the trends of ED various ED discharges and the impact on subsequent short-term ED return rates.
Methods: A multi-center retrospective longitudinal cohort study of ED visits from all 325 licensed non-military acute care hospitals in California during a 9-year period from 2008 thru 2016 using non-public statewide datasets. Visits that resulted in discharged were evaluated comparing the differences between those discharged home to self-care, discharged to a SNF and discharged with home health services. The primary outcome was the frequency of such discharges over the 9-year study period. In addition, we compared groups in terms of short-term return 7-day return visits to the ED. Statistical analysis was performed using IBM SPSS Statistics 25.
Results: ED visits to acute care hospitals increased from 8,294,036 visits in 2008 to 11,575,631 visits in 2016. During that time, ED discharges home increased from 75.5% to 78.6% of all discharges (7,547 to 7,861 discharges per 10k visits, p>0.05). ED discharges with home care services significantly increased from 0.0% to 0.3% (4 to 27 discharges per 10k visits, p<0.001. SNF discharges increased from 0.3% to 0.4% (33 to 43 discharges per 10k visits, p<0.001). Seven-day return visit rates to the ED were not significantly different for patients discharged home (13.8% in both years, p>0.05), but significantly decreased for those discharged to home health services (17.4% to 14.0%, p<0.001) and significantly increased for those discharged to a SNF (14.6% to 17.2%, p<0.001).
Conclusion: In this large multicenter study of 325 EDs in California over 9 years, use of home care services on discharge from the ED increased nearly 10-fold. There was no difference in short-term ED return visits between those discharged with services versus those without.