Aging & Social Change: Ninth Interdisciplinary Conference

Abstract

Presentation to the emergency department (ED) for non‑emergent reasons is of growing concern nationwide for geriatric patient populations with multiple chronic comorbidities and complex psycho‑social health determinants. The aim of this retrospective observational chart review is to compare hospital and ED encounters after patient establishment in the Medvantage (MV) clinic. Secondary aims are to examine the distribution of integrated primary care interventions such as case management referrals and home‑based care services within the MV clinic. Chart reviews were conducted for patients with the clinic >2 months with >12 months prior data. Patient demographics, health disparities and home‑based care services are provided along with a bivariate comparison of monthly ED/hospital admission rates. The (N=297) average monthly rate of ED use before and after MV clinic establishment was 0.14 and 0.08 respectively. Hospital admission before and after was 0.07 and 0.04. 35% of patients had case management referrals and 62.8% received some form of home‑based care, including home health, palliative care, and PCP home visits. The most prevalent health disparities within the study population sourced from case management intake assessments were financial support, medication, housing, health literacy, and transportation barriers. This study reveals a 57% reduction in both ED utilization and hospital admissions after clinic establishment. Coordinated and transdisciplinary care delivered through patient‑centered primary care teams appears to reduce emergency department usage. Primary care initiatives must focus on the social determinants of health, and care teams must be prepared to deliver intensive and longitudinal psychosocial and clinical interventions.