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Reliance on emergency rooms 'signals a failure' of health care system

By Mike Sherry for KHI News Service, April 13, 2012

A new report has identified 10 “hot spots” on the east side of Kansas City, Mo., where low-income residents depend upon emergency rooms as their first resort for medical care.

“Reliance on emergency rooms clearly signals a failure of our health care delivery system and represents an ineffective use of limited health care dollars that does not serve anyone in the system well,” according to the report, which was compiled by the Kirwan Institute for the Study of Race & Ethnicity at Ohio State University in conjunction with local and national partners.

Jerry Jones, who contributed to the report as a community organizer with the Kansas City-based Communities Creating Opportunity, said he hoped the report would be a wake-up call for addressing health disparities in the city.

“It’s kind of like a cold glass of water for people who have kind of taken things for granted,” he said, “and to say, ‘Hey, we have to act, and if we don’t change this trend, it will only continue, it will only get worse.”

Along with the figures on emergency room visits, the report mapped locations of primary-care physicians showing that only about 12 percent of the 257 offices around the city were located within the 10 hot spot zip codes, though the zip code areas hold about 20 percent of the city’s population.

The data also showed that in some cases residents in the 10 hotspots had a life expectancy nine years less than in zip codes where emergency rooms were used less frequently.

Using 2011 emergency room data compiled by the Kansas City Health Department, the Kirwan Institute found that high-usage areas had at least 659 emergency room visits per 1,000 residents, which was more than three times the rate in the zip codes with the lowest utilization.

Also, according to the report, there were disproportionately high percentages of people eligible for Medicaid within the hotspot zip codes, suggesting that the expected expansion of Medicaid through the federal Affordable Care Act in 2014 might not reduce the problem of low-income residents using emergency rooms for primary care.

Attracting primary care physicians back into these neighborhoods would be difficult, said Kirwan Institute Research Director Jason Reece, who co-authored the study.

The doctors generally have joined the flight of services away from these neighborhoods, he said. The suburbs offer patients with better-paying private insurance plans.

Mobile clinics that ply the neighborhoods and primary care services for children offered at schools could help solve the problem. But solutions will need to be specific to an area because of the variety of reasons driving people to emergency rooms in search of basic care, Reece said, noting that the report was a step in understanding the problem.

“One of the goals of doing this hot spot analysis is that you can’t fix all of those problems everywhere at one time,” Reece said, “but if you have a particular community where you know a lot of people went to the ER for chronic conditions and for things that should’ve been hit with preventive care, there is more of a potential to have a big fundamental impact in those neighborhoods.”

Any number of reasons can prompt excessive use of the emergency room, Reece said, ranging from a lack of transportation to neighborhood norms that accept the ER as the place to get routine medical care.

The report also recommends that hospitals themselves identify chronic users of the emergency room and devise targeted interventions.

That is exactly what Truman Medical Centers has been doing for the last two years through its Guided Chronic Care and Passport to Wellness programs.

Guided Chronic Care works with patients with heart problems, who tend to be frequent users of the emergency room. Passport to Wellness focuses on individuals treated routinely as inpatients or in the emergency room.

The programs have about 150 patients combined, according to Gael Martin, the medical center’s associate director of corporate care continuity services. In each program, a social worker and a nurse work with each patient to reduce barriers they might have receiving care or following doctors’ orders.

“The whole aim is to empower the patient to self-manage better and use the health system wisely,” Martin said. “We don’t want them to stop using the system, because they need it, but we want them to use it when it’s appropriate.”

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