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Randomized Controlled Trial
. 2017 Jun;18(4):743-751.
doi: 10.5811/westjem.2017.2.32570. Epub 2017 Apr 19.

Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation

Jessica R Schumacher  1 , Barbara J Lutz  2 , Allyson G Hall  3 , Jesse M Pines  4 , Andrea L Jones  5 , Phyllis Hendry  6 , Colleen Kalynych  6 , Donna L Carden  1
Affiliations
Randomized Controlled Trial

Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation

Jessica R Schumacher et al. West J Emerg Med. 2017 Jun.

Abstract

Introduction: Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients' care-seeking decisions.

Methods: We conducted a mixed-methods study including a randomized controlled trial and in-depth interviews in two EDs in northern Florida. Participants were chronically ill older ED patients with limited health literacy and Medicare as a payer source. Patients were assigned to an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitative interviews (n=9) explored patients' reasons for ED use. We assessed average between-group differences in patient engagement over time with the Patient Activation Measure (PAM) tool, using logistic regression and a difference-in-difference approach. Between-group differences in follow-up doctor visits were determined. We analyzed qualitative data using open coding and thematic analysis.

Results: PAM scores fell in both groups after the ED visit but fell significantly more in "usual care" (average decline -4.64) than "intervention" participants (average decline -2.77) (β=1.87, p=0.043). There were no between-group differences in doctor visits. Patients described well-informed reasons for ED visits including onset and severity of symptoms, lack of timely provider access, and immediate and comprehensive ED care.

Conclusion: The coaching intervention significantly reduced declines in patient engagement observed after usual post-ED care. Patients reported well-informed reasons for ED use and will likely continue to make ED visits unless strategies, such as ED-initiated coaching, are implemented to help vulnerable patients better manage their health and healthcare.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. This study (ClinicalTrials.gov number, 01973296) was funded by a Health Policy Grant from the Emergency Medicine Foundation and supported by the UF Clinical and Translational Science Institute, the NIH National Center for Advancing Translational Sciences (UL1 TR000064), and the Patient-Centered Outcomes Research Institute (IHS-1306-01451). The opinions in this paper are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee.

Figures

Figure
Figure
Recruitment procedures. Consolidated standards of reporting trials (CONSORT) flow diagram displaying progress of all participants through the trial.
See this image and copyright information in PMC

References

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