Effectiveness of a Nurse-Led Ambulatory Care Clinic in Reducing Emergency Department Visits and Hospitalizations
Published Web Location
https://doi.org/10.5811/westjem.53190
Abstract
Introduction: Gaps in care integration and coordination contribute to emergency department (ED) crowding and preventable hospitalizations, necessitating innovative solutions to improve care transitions and reduce acute care use. This study evaluates whether attendance at a nurse-led ambulatory intermediate care clinic (AICC) reduces three-month ED visits and hospitalizations compared to missed AICC appointments.
Methods: This retrospective cohort study at a single academic center analyzed AICC appointments from the first three years of clinic operations using multivariable logistic regression models, controlling for demographic, socioeconomic, and clinical factors. Our primary outcome measure was an ED visit within three months of the AICC appointment; our secondary outcome measure was hospitalization within three months. Robustness was assessed using Poisson, negative binomial, and zero-inflated models.
Results: Among 2,698 appointments analyzed (mean age 51.5 years; 49.7% female), patients who attended their AICC appointment had a lower absolute ED visit rate compared with those who missed it (250/2,389 [10.5%] vs 47/309 [15.2%]; risk difference, 4.75%; 95% CI, 0.56-8.93%; P = .03). Missing an AICC appointment was significantly associated with greater odds of an ED visit (OR, 1.54; 95% CI, 1.07-2.21; P = .02). Hospitalization rates were 47.3% versus 53.4% (P = .04), although missing an AICC appointment was not significantly associated with increased hospitalizations (OR, 1.28; 95% CI, 1.00-1.64; P = .05). Findings were consistent across robustness analyses.
Conclusion: The ambulatory intermediate care clinic model was associated with fewer ED visits but not reduced hospitalizations, suggesting that intermediate care can improve timely access and address acute care needs but may be insufficient to influence more complex drivers of inpatient admissions. Future research should explore strategies to enhance coordination and optimize the role of intermediate care within broader health system workflows.