Optimizing care pathways: A study of the urgent dispatch program and its impact on emergency department visits.

INTRODUCTION: The use of acute hospital-level care at home (hospital-at-home) for patients who are chronically ill has led to decreased medical costs, amount of sedentary time, and hospital admissions. Our large integrated healthcare system identified the need to develop a mechanism through which to decrease emergency department (ED) visits in this patient population by creating a home acute care program called Urgent Dispatch. The primary objective of this study was to determine the medical condition for referral and seven and 30-day ED visit rates. METHODS: This was a retrospective cohort of all patients referred to the Urgent Dispatch program from April 1, 2021, through February 28, 2022. We assessed encounters for patient demographics, referral source, reason for visit, number of at home visits, total number of days in the program, and determined if the patient had an ED encounter within seven and 30 days of participation in the program. The healthcare system includes 10 hospitals (academic, community and rural), 17 emergency departments (hospital-based and freestanding) and their associated outpatient clinics. RESULTS: A total of 2218 orders were placed with 1530 (70.8 %) resulting in enrollment in the Urgent Dispatch program. The majority were elderly (75 ± 15.6), white (70 %), female (64.4 %), and had Medicare as their primary insurance (82 %). The average number of visits made by Urgent Dispatch was 1.46 (SD ± 0.95). The average number of days enrolled in the program was 2.4 (SD ± 4.1). The top three referral sources to the program were outpatient primary care (42 %), home care (28 %) and emergency medicine (20 %). The top body systems requiring a visit were cardiovascular (22 %), general (18 %), and respiratory (17.2 %). Of the 1530 urgent dispatch referrals, 19.8 % (n = 303) had an ED visit within seven days, 12 % (n = 183) had an ED visit within eight to 30 days, and 68.2 % (n = 1044) had no ED visit. CONCLUSION: A home-based care model of healthcare delivery for patients with chronic medical conditions can provide effective care, with 80.2 % of patients avoiding an ED visit within seven days and 68.2 % avoiding an ED visit within 30 days.

Introduction to the Special Issue on Taking Home Visiting to Scale: Findings from the Maternal, Infant, and Early Childhood Home Visiting Program State-Led Evaluations.

The Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program is a two-generation approach to supporting healthy families through home visits during pregnancy and early childhood. All states and territories receiving MIECHV funding are encouraged to evaluate their programs. This special issue highlights evaluations from 11 awardees-Arkansas, Florida, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Jersey, Oregon, Pennsylvania, and Tennessee. With the wide expansion of home visiting since the onset of MIECHV, the state-led evaluations contribute to the understanding of replication and scale-up of evidence-based home visiting.

Correction to: Introduction to the Special Issue on Taking Home Visiting to Scale: Findings from the Maternal, Infant, and Early Childhood Home Visiting Program State-Led Evaluations.

The article "Introduction to the Special Issue on Taking Home Visiting to Scale: Findings from the Maternal, Infant, and Early Childhood Home Visiting Program State-Led Evaluations", written by Nicole Denmark, Kyle Peplinski, Mariel Sparr, Judy Labiner-Wolfe, Susan Zaid, Pooja Gupta and Kassie Mae Miller, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 19 June 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 18 July 2018 to