R5 InitiativeImproving Access to the Right Care in the Right Place at the Right Time for the Right Reason at the Right Cost

Erin KnoerlEPI 621April 29, 2010

Introduction•Healthy Capital District Initiative

•Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) Phase IX grant

•HEAL goals▫Identify causes of sub-optimal ED utilization▫Identify and adopt promising best practices▫Increase patient and provider engagement

Introduction

•18% increase in ED visits from 1994-2004•12.4% decrease in #’s of ED•55% of ED visits- non-urgent (National Center for

Health Statistics)

•$1.3 billon- annual cost for NYS (National Association of Community Health Centers)

▫$2.7 billon- one local hospital▫~$12 million for Capital Region

Introduction-Objectives

•Determine: ▫What areas are the largest utilizers of ED

services Primary Care Related Non-Urgent

▫If insurance type affects ED visit type▫If the presence of hospitals affects the visit

rate

•To see the general trend of data

Methods- NYU Algorithm

•NYU Center for Health and Public Service Research, Commonwealth Fund, Robert Wood Johnson Foundation, and United Hospital Fund of NY

•Used to help classify ED utilization•Based on hospital records

▫Data driven▫Each record classified into 1 of 4 categories

Methods- Visit Types

•Non-Emergent▫Care not needed within 12 hours

•Emergent- Primary Care Treatable▫Treatment needed within 12 hours▫Other places could treat-

equipment/resources▫No constant observation

Methods- Visit Types

•Emergent- Primary Care Preventable▫ED care required- complaint or resources▫Condition preventable- timely care

•Emergent- Not Preventable▫ED care required▫Ambulatory care- not preventable

Methods- Data•Sources

▫SPARCS data▫I drive

NYS Zips 2004 NYS Hospital

▫Google Earth•Software

▫Map Info▫Google Earth▫Excel

Methods- Mapping

•Capital Region- 3 counties▫69 Zip codes▫35 Zip code groupings

•Hospitals▫NYS, MA, VT

•Thematic maps

Results