Baylor Scott & White takes a population health-based approach to reduce ER, inpatient visits

Baylor Scott & White greatly reduced emergency department overuse and inpatient visits by setting up a wellness facility in a city recreation center, according to a new study. 

The health system launched the BSW Health and Wellness Center in partnership with the local recreation department to offer primary care services alongside wellness programs aimed at helping residents in a traditionally low income and underserved area of Dallas, according to research published in Health Affairs. 

The researchers followed about 1,000 patients who visited an ED or inpatient facility either the year before or the year after they visited the wellness center. Treating these patients at the wellness center led to a 21.4% reduction in emergency room visits and 36.7% decrease in inpatient care visits. 

Offering the wellness centers' services as an intervention also led to lower costs, with ED costs decreasing by 34.5% on average and inpatient costs dropping 54.4% on average. 

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The emergency room has been a prime target for initiatives aimed at reducing healthcare use and costs. Expanding patients' access to primary care has been a crucial centerpiece to these programs, with more hospitals connecting patients to primary care providers from the emergency department and embedding care management programs in the ED. 

The BSW researchers said their findings are in line with the long-held belief that increased access to primary care through the wellness clinic led to fewer ED visits. 

However, according to the study, it was the other population health programs embedded in the wellness center—such as offering fresh produce and providing access to social workers—that was a greater driver of inpatient care use reductions. 

"As health care continues to evolve from acute “sick care” to the management and prevention of chronic disease, new approaches will arise from the creativity and leadership of, and collaboration among, professionals from a wide range of disciplines focused on the value of improved health outcomes," the researchers said. 

RELATED: New York hospitals take aim at ER 'super users' 

Hospitals looking to flag which patients are most likely to be superusers should monitor intensity of use, as that is a more likely indicator than any specific socioeconomic factors. Persistent ED use is also not often consistent, and may drop off over time for many patients. 

In addition, research suggests that relatively few ED visits are truly unnecessary. A recent analysis found that just 3.3% of visits were avoidable, or required no tests, screenings, procedures or medications.