4 safe, cost-reducing strategies for treating acute conditions without hospitalization

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As hospitals strive to meet the challenges of value-based care, recognizing the best settings to diagnose and manage serious conditions with sudden onset can be a useful way for organizations to improve outcomes and reduce costs.

A new study published in JAMA Internal Medicine examined the safety and efficacy of four alternative care delivery models for acute, low-risk medical conditions designed to treat said conditions without hospitalization. All strategies were found to be safe.

For the study, researchers analyzed data from major study databases for systemic reviews conducted on four alternative care models from 1995 to 2016. Conditions managed by the strategies included pulmonary embolism, deep venous thrombosis, pneumonia, chest pain, kidney stones and worsening symptoms of heart failure or emphysema. Examination of 22 studies revealed that the alternative strategies improved both patient and caregiver satisfaction, while reducing costs without compromising patient safety.

Here are the four alternative care strategies for the treatment of certain acute conditions without hospitalization.

1. Conducting outpatient management after completion of initial diagnosis in either an outpatient clinic or hospital emergency department.

2. Treating patients at quick diagnostic outpatient units designed to rapidly identify serious conditions like cancer, the identification of which would traditionally be conducted during an inpatient hospital admission.

3. Providing patients with at home hospital programs designed to deliver inpatient-level care following an initial evaluation in an emergency department or outpatient clinic.

4. Treating patients in observation units created to provide care for patients for up to 48 hours and following up with outpatient care.

"Patients often prefer to obtain care at home and avoid hospitalization, as long as safety and quality are not compromised," said Jared Conley, MD, PhD, of the Massachusetts General Hospital Department of Emergency Medicine in Boston and lead author of the report. "The growing body of evidence demonstrating the safety and increased desirability of managing low-risk acute care without hospitalization may give us the opportunity to improve the health of populations and of individual patients at a more affordable and sustainable cost."

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