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LONG BRANCH, NJ, FEBRUARY 5, 2009 – Use of hospital emergency
departments for non-emergent health care has long been a concern
of providers and policy makers, as ER’s are not able to
provide continuity of care, ongoing patient education and chronic
care management — all hallmarks of quality primary care.
To address this concern, Monmouth Medical Center, an affiliate
of the Saint Barnabas Health Care System, has begun a 21-month
study designed to encourage and support the transition of patients
from the hospital Emergency Department (ED) to appropriate community
providers for their primary care needs.
As one of only two sites in New Jersey to pilot this program — Newark
Beth Israel Medical Center, Monmouth’s sister hospital
is the other — Monmouth will test a model of providing
alternate non-emergency services to patients who depend on the
hospital for their primary care needs, as well as providing patient
education and support services to encourage use of more appropriate
sites of care.
“Studies have found that a number of ED visits are for
non-urgent medical care that would be more appropriately treated
in primary care settings,” says Frank J. Vozos, M.D., FACS,
executive director of Monmouth Medical Center. “Directing
non-urgent care to primary care settings can improve the coordination
of care for patients and preserve the ER for those who truly
need emergency care.”
He points to services such as the primary care clinic opened
in downtown Long Branch by Monmouth Medical Center in 1997 to
increase access to primary care as testament to the hospital’s
continuing commitment to caring for the community’s medically
underserved in the most appropriate setting.
“In 2004, in order to further increase that access, Monmouth
Medical Center asked the federal government to approve a new,
independent entity known as Monmouth Family Health Center,” Dr.
Vozos says. “And as a Federally Qualified Health Center,
it has continued to serve medically underserved patients and
increase outreach and support services to be even more responsive
to the complex needs of our service area population.”
Inappropriate use of the ED is a problem that leads to overcrowding
and can impede care for those with more emergent conditions,
but, according to Catherine Hanlon, M.D., chair of emergency
medicine at Monmouth, use of the ED for non-emergent conditions
can be an indicator of access barriers to more appropriate primary
care. She notes that the Community Partnership for Emergency
Department Express Care and Case Management project is designed
to address social issues that create barriers to care including
illiteracy, language barriers, homelessness, and/or lack of transportation,
as well as financial barriers, as patients are often covered
by Medicaid, or may be eligible for benefits but have not applied
for them.
“While many urban ED visits occur for non-urgent conditions
such as upper respiratory infections, viral infections, earaches
and sore throats, we understand that because these individuals
typically face a multitude of barriers in accessing other providers,
the ED becomes their provider of choice,” Dr. Hanlon says. “The
purpose of this pilot project is both to improve the health of
the patients and to teach them to seek services from appropriate
locations rather than the ED.”
The use of hospital emergency departments for conditions that
would be more appropriately cared for in a primary care setting
is a growing problem nationwide, but is particularly acute in
New Jersey, where about 18 percent of all hospital ED visits
in a typical year were for primary care conditions, according
to the New Jersey Hospital Association's (NJHA) Health Research
and Educational Trust (HRET), which is implementing the pilot
program jointly with the State of New Jersey's Department of
Human Services' Division of Medical Assistance and Health Services
and the New Jersey Primary Care Association. Funding for
the program has been provided to 20 states including New Jersey
through the Center for Medicare and Medicaid Services.
“We want to ensure that patients receive the right care,
at the right time, in the right setting,” said NJHA President
and CEO Betsy Ryan. “That’s central to the healthcare
community’s goal of providing efficient and high-quality
healthcare to the people of New Jersey.”
As part of the project's requirements, all patients who come
to the ED will be triaged and receive a medical screening by
an advanced practice nurse (APN), according to Dr. Hanlon.
“Once a patient is determined to have non-emergency primary
care needs, the APN will provide express primary care services
and prescriptions, and then schedule a follow-up appointment
with a primary care provider in the community, such as a doctor
or at a health center such as the Monmouth Family Health Center,” she
says. “All uninsured patients will also be screened for
eligibility in public health coverage programs.”
Throughout the pilot program, case managers will monitor ED
use, track compliance with follow-up visits, identify repeat
ED users, determine their reason for using the ED for non-emergent
conditions, and help them resolve barriers to using appropriate
primary care sites. The ED Express Care pilot program will primarily
target Medicaid patients, but its ultimate goal is to provide
care to all New Jersey residents in the most appropriate, efficient
and cost-effective site.
"Ultimately, the study seeks to create a system that is more
user friendly and more responsive to individual needs of all
patients," says Firoozeh Vali, Ph.D., vice president, research
for NJHA.
Dr. Hanlon, said, “Numerous public health studies have
shown that consistent use of primary care services for treatment,
monitoring, and prevention — rather than the episodic use
of ED’s — leads to lower hospitalization rates for
those with chronic illnesses such as diabetes, asthma, heart
failure and hypertension and shorter lengths of stay for those
who are hospitalized. Additionally, these studies show increased
savings not just to the health care system but to individuals
in terms of lost wages and productivity from their jobs.”
Monmouth's Cline-D’Onofrio Emergency Services Pavilion
treats more than 50,000 patients annually. A dedicated pediatric
emergency department ensures that critically ill or injured children
receive highly specialized care from the moment they enter the
hospital.
To learn more about emergency services at Monmouth Medical Center,
call 1-888-724-7123 or visit www.barnabashealth.org.
CONTACT: Kristine A. Brown
Director of Public Relations
732-557-3902
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