Enhancing Value-Based Care With a Walk-in Clinic: A Primary Care Provider Intervention to Decrease Low Acuity Emergency Department Overutilization

Cureus · 2021-02-11 · 14 citations

had a walk-in clinic visit at the family practice. ED visits were tracked from January 2018 to January 2020 and encounters were compared numbers to pre and post-implementation of a walk-in clinic. Cost savings for comparable management was estimated with average price differences for low acuity encounters in the ED versus clinic. Results Over the two-year timeframe, there were 10,962 total visits to the ED by family practice patients, 4,250 of these visits were low acuity. Despite gross monthly increases of EDU from 2018-2020, after implementation of a walk-in clinic in 2019, rates of total EDU decreased by 1.5% and low acuity utilization rates also decreased. The average annual patient census nearly doubled from 5,763 to 8,042. T-tests confirmed statistical significance with p-values <0.05. Average low acuity ED visits ($437) cost 4.9 times more than comparable PCP office visits ($91). Managing 2,387 patients in the walk-in clinic resulted in an estimated annual cost savings of $825,902. Conclusion Extended walk-in availability in primary care offices provides non-ED capacity for low acuity management and might mitigate low acuity ED utilization while providing more cost-effective care. This study supports similarly described pre-hospital diversions in reducing ED over-utilization by increasing access to care. Higher levels of evidence are needed to establish causality.

Limiting Elective Delivery Prior to 39 Weeks May Be Producing Harm Rather Than Benefit

JAMA Pediatrics · 2018-10-16

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal

Pilot Randomized Trial of an Automated Smoking Cessation Intervention via Mobile Phone Text Messages as an Adjunct to Varenicline in Primary Care

Journal of Health Communication · 2018-03-26 · 20 citations

OBJECTIVE: Varenicline is a safe and effective aid to smoking cessation but most trials have involved frequent visits or intensive behavioral support unlike that typically provided in primary care. The current study examined if motivational text messages, sent via cellphone, would increase quit rates in smokers being treated with varenicline and 3 brief sessions in a family practice setting. METHODS: This study was a randomized controlled, parallel-group smoking cessation trial. Intervention group participants (n = 74) received daily motivational text messages, additional texted tips in response to keywords, and weekly study questions while control group participants (n = 76) received only weekly study questions. Both groups received individualized counseling. Self-reported non-smoking and exhaled breath CO <10ppm were used to validate smoking abstinence at 3 weeks and 12 weeks. RESULTS: Overall, 30.7% (46/150) of participants were abstinent at the 12 week follow-up and the abstinence rate did not differ between groups (INT 31.1% v. CON 30.3%, p = .91). The only predictor of abstinence at 12 weeks was use of varenicline during a previous quit attempt (p = .01). Intervention group participants were more likely to rate the text messaging program as good or excellent (p < .01), to recommend a similar program to family or friends (p < .01), and to complete positive smoking cessation activities (p = .04), when compared with the control group. CONCLUSION: Although there were no differences in quit rates between the intervention and control group, intervention group participants rated the text messaging system more favorably, were more likely to recommend the program to others, and were more likely to complete positive smoking cessation activities.

US Term Stillbirth Rates and the 39-Week Rule: A Cause for Concern?

Obstetric Anesthesia Digest · 2017-02-15 · 2 citations

( Am J Obstet Gynecol. 2016;214(5):621.e1–621.e9) The restriction of the use of “elective” delivery before 39 weeks 0 days of gestation, known as “the 39-week rule” or “the Rule,” was mandated in 2010 in the United States. The Rule was applicable to both labor induction and prelabor cesarean delivery, and was developed as higher rates of adverse childbirth outcomes, including infant morbidity and mortality, subsequent to deliveries that occurred before 39 weeks 0 days of gestation had been reported. However, the prospective risk of term stillbirth was known to increase as a function of increasing gestational age, and hence it was speculated that the Rule might increase the overall rate of term stillbirth. This study aimed to determine whether the term stillbirth rate increased during the 7-year period that the 39-week rule was adopted. The number of live births and the number of stillbirths that occurred within each week of gestational age at and further than 37 weeks were obtained from the state health departments for the years 2007 to 2013. The patterns of the timing of term childbirth and term stillbirth were determined as a function of calendar year and gestational age for each state and for the United States overall. The number needed to treat, which represented the number of women who would need to have an early-term delivery without an accepted indication to prevent one term stillbirth, was estimated based on the change in the proportion of deliveries that occurred before the 39th week of gestation in 2013 compared with 2007, and by the estimated change in the incidence of term stillbirth that occurred in 2013 compared with 2007.

The association between the regular use of early-term labor induction and improved birth outcomes: new evidence from an Italian hospital

Minerva Obstetrics and Gynecology · 2017-07-01 · 1 citations

BACKGROUND: Associations have been recently reported between the frequent use of early-term preventive labor induction and improvements in multiple parameters of birth health. We sought to replicate these findings in an Italian hospital. METHODS: The outcomes of 120 consecutively delivered women who were exposed to the alternative method of care were compared to the outcomes of 159 women who received standard management. The primary and secondary outcomes were group cesarean delivery rate and group adverse outcome index score. RESULTS: Exposed women had a higher induction rate, a lower cesarean delivery rate (1.7% vs. 43.4%), and a lower group AOI Score (0.2 vs.5.8). CONCLUSIONS: Exposure to high levels of early term preventive labor induction was associated with a lower group cesarean delivery rate and improvement in several other major birth outcomes. An adequately powered randomized controlled trial is needed to further explore this alternative method of care.

ANTITRUST: SOUND AND FURY?

2016-01-01

and has no special vested interest in the antitrust laws. His perceptions are not clouded by the mists of past personal failures or successes, and he has no need to advocate or defend anything but the paramount public policies for which he shares responsibility. Because he is new he has a kind of directness that is sometimes startling. To recall an old fable, Commissioner Nicholson is the sort of person who will point out the fact that the king is wearing no clothes.

A Multi-State Analysis of Early-Term Delivery Trends and the Association With Term Stillbirth Trends in Stillbirth by Gestational Age in the United States, 2006–2012 Stillbirth and the 39-Week Rule

Obstetrics and Gynecology · 2016-03-24 · 1 citations

Nicholson, James MD; Kellar, Lisa MD; Ahmad, Shahla MD; Abid, Ayesha MD; Henning, George MD; Ural, Serdar MD; Yaklic, Jerome MD Author Information

US term stillbirth rates and the 39-week rule: a cause for concern?

American Journal of Obstetrics and Gynecology · 2016-02-13 · 91 citations

Reply

American Journal of Obstetrics and Gynecology · 2016-08-25

928: Cost implications of higher term labor induction rates

American Journal of Obstetrics and Gynecology · 2016-12-27