[Efficiency of streaming and integrated care models for low acuity patients in acute and emergency care-results from a prospective cohort study].

introductionAccording to the emergency care reform, streaming low-acuity patients to outpatient care structures seeks to relieve emergency departments (EDs). The aim was to compare the care efficiency of different streaming models at the ED site.

methodsThis prospective, multicenter cohort study compared three study arms in a primary-data cohort of low-acuity patients and a routine-data cohort of unselected patients: 1) a hospital-operated outpatient practice (hospital practice), 2) an on-call practice operated by the Association of Statutory Health Insurance Physicians (SHI practice), and 3) standard care with physician-assessed streaming potential. The primary endpoint was care efficiency: the proportion of patients directed to the alternative care structure or the assessed streaming potential. The secondary endpoint was patient safety (ED revisit, hospital admission).

resultsAmong low-acuity patients (primary-data cohort: n = 1096), care efficiency was 49.5% (n = 145) for the hospital practice and 77.2% (n = 322) for the SHI practice. The physician-assessed streaming potential was 73.4% (n = 240). Among unselected ED patients (routine-data cohort: n = 68.010), care efficiency was 11.4% (n = 2558) for the hospital practice and 29.9% (n = 13.668) for the SHI practice. An ED revisit within 30 days occurred in 2.1% (n = 1) after treatment in the hospital practice (no hospital admissions) and in 10.4% (n = 14) after treatment in the SHI practice (hospital admissions: 7.5%, n = 10). DISCUSSION: The streaming and care of low-acuity patients at the ED site was more efficient in the SHI practice but was associated with potentially greater safety risks. Care efficiency in the primary-data cohort is likely overestimated due to recruitment, whereas the routine-data cohort provides more realistic estimates.