Community Outreach for Patient Engagement

Purpose: : There is a critical need to address patients’ difficulty with accessing primary/subspecialty care, resulting in frequent ED visits. For patients that visit the ED >3 times in 90 days, the Community Outreach for Patient Engagement (COPE) program aims to reduce ED utilization and address rural health care disparities through improved access to healthcare.

Design: : This is a randomized controlled trial using implementation framework.

Setting:: This study takes place in a level 1 trauma center in rural New England.

Sample:: Patients who have visited our ED greater than three times in the past 90 days are included in this study. Exclusion criteria includes a recent history of violence, and being under the age of 18. Participants meeting eligibility criteria are randomly assigned in a 1:1 ratio to the in-person (intervention) or telephone follow-up only (control) groups.

Methods: : In-person, low barrier visits occur in the community, and address clinical and social determinants of health needs. Based on patient’s needs, these visits occur as frequently as daily, ranging to weekly. Our primary analysis is based on the intention-to-treat principle. We are tracking engagement with primary care, overall health, food security and safety. ED utilization and hospital admission are compared to the subject’s number of visits and admissions during the year prior to enrollment.

Results: : 30% of patients in the COPE pathway were assigned a high acuity, compared to 29% of patients in the phone call pathway. Patients in the COPE pathway had 15.1 pre-enrollment ED visits, and 14.2 post enrollment visits (a change of -1.0). Patients in the phone call pathway had 12.8 pre-enrollment ED visits, and 14.9 post enrollment ED visits (a change of -0.25). A cost benefit analysis was completed. The decrease in ED visits shows a cost avoidance of $4,361, and the decrease in hospital admissions results in a cost avoidance of $322,218.
The COPE pathway’s hard savings of $366,579, minus project costs of $50,000 show a return on investment (ROI) of $316,579, or a cost ratio of 7.33. We estimate that 27 Emergency Medical Services (EMS) calls were avoided as part of the COPE pathway.

Implications:: Patients in the COPE pathway have 3.1 fewer ED visits/year than those in the phone call pathway, and 1.17 fewer admissions. This data shows that the COPE pathway has a positive impact on reducing ED utilization. At a time when the ED is facing unprecedented staffing shortages, paired with increasing patient acuity, decreasing resource utilization will benefit Emergency Medicine. We would like to investigate further uses of this community-based approach to Emergency Medicine. Specifically, we are interested in investigating the COPE team’s involvement in facilitating the initiation of Medications for Opioid Use Disorder (MOUD).