Health Policy Journal Club, Health Policy, Advocacy, Health Care Administration, Social EM

Health Policy Journal Club: Collaboration Is Key

Care Coordination Decreased Inpatient Hospitalizations by 40%

The population of older adults is expected to double by 2050 – and it is anticipated that emergency department visits and hospitalizations among this group will continue to rise. Given our already overburdened health care system, which has become even more strained with the COVID-19 pandemic, it will be pivotal to identify interventions that can reduce the strain on hospitals and health care workers.

A recent article did just that by assessing changes in healthcare utilization after enrolling older adults in a community care connection program. The program aimed to coordinate health care and social services for older adults to minimize hospitalizations and emergency department visits and to improve health outcomes. Interestingly, the program was associated with 40% fewer inpatient hospitalizations within the 90 days after program enrollment but was not associated with fewer ED visits. The authors suspect the absence of reduced ED visits could be due to errors in matching the enrollment group to the comparison adult group, underlying institutional or social factors, or the continued care-seeking behavior of the patients who desired to visit the ED.

Overall this paper is consistent with previous studies showing evidence of decreased hospitalizations upon the addition of social interventions. Managing patient’s medical issues without addressing their social needs ignores the effect of social determinants on health. The joining of health care and social programs, such as meal programs and care coordination, can be fundamental in improving health care systems and patient care overall. However, the data are not straightforward. A systematic review revealed the limited availability of research on emergency department visit reduction programs, and a recent randomized controlled trial regarding assigning health care super-utilizers to a care-transition program failed to reduce readmission rates. The union between health care and social programs remains a complex issue and the previously mentioned research demonstrates the need for additional studies and discussion in this area.

We as emergency physicians are aware of the importance that social needs have on health, yet the health care system itself lags behind. There remains a huge imbalance between national funding for health care and health improvement. Of the nearly $4 trillion spent on health, 95% goes directly to medical care services, while just 5% is put aside for population health improvement. This represents a large area for opportunity to connect social services to healthcare, which could simultaneously improve patient health and reduce the burden on our health care system.


Article: Fisher EM, AKiya K, Wells A, Li Y, Peck C, Pagan JA. Aligning social and health care services: The case of Community Care Connections. Prev Med. 2021;143:106350.

The Community Care Connections (CCC) program aims to align social and healthcare services to improve health outcomes in older adults with complex medical and social needs. This study assessed changes in healthcare utilization before and after CCC program participation. Between June 2016 and March 2019, 1214 adults with complete data who provided informed consent participated in the CCC program. CCC client data were linked with data on hospitalizations, emergency department (ED) visits, and observation stays 90 days before and after the program start. Data analysis examined changes in health care utilization 90 days after program start, compared to 90 days before. Hospitalizations decreased by 30% (Change = -0.029, 95% Confidence Interval (CI) = -0.053, -0.005), ED visits decreased by 29% (Change = -0.114, 95% CI = -0.163, -0.066), and observation stays decreased by 23% (Change = -0.041, 95% CI = -0.073, -0.009) during the post period. ED visits decreased by 37% (Change = -0.140, 95% CI = -0.209, -0.070) for those with hypertension and by 30% (Change = -0.109, 95% CI = -0.199, -0.020) for those with high cholesterol, while observation stays decreased by 46% (Change = -0.118, 95% CI = -0.185, -0.052) for those with diabetes and by 44% (Change = -0.082, 95% CI = -0.150, -0.014) for those with high cholesterol during the post period. Connecting older adults with social services through the healthcare delivery system may lead to decreases in hospitalizations, ED visits, and observation stays. Implementation of cross-sector partnerships that address non-clinical factors that impact the health of older adults may reduce the use of costly healthcare services.

PMID: 33253760

EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA

As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care providers, and the lack of mental health services - are universal problems. As EM residents and fellows,  we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula. This is the gap this initiative aims to fill.  Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.