Assesses ED visits for members 18 years of age and older who have multiple high-risk chronic conditions and who had a follow-up service within 7 days of an ED visit.
Why It Matters
The U.S. Department of Health and Human Services estimates that one in four adults in the US and three in four older adults 65 and older have multiple chronic conditions.1 The Centers for Medicare & Medicaid Services found that in 2014, 30.1% of Medicare beneficiaries had two or three chronic conditions, 20.9% had four or five and 14.5% had six or more.2
These Medicare beneficiaries are at particular risk following ED visits because of their functional limitations, audio and visual impairments and use of multiple medications.3 One study found that older adults discharged from the ED had an average mortality rate of 10%, an average ED readmission rate of 24% and an average post-discharge hospitalization rate of 24% within the first three months after the ED visit.4
Studies show that communication challenges and adverse health outcomes persist because hospitals, including ED providers, face few repercussions for failing to send medical records to patients’ outpatient providers upon admission and following discharge.5
Results – National Averages
Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Condition- Total
| Year | Medicare HMO | Medicare PPO |
|---|---|---|
| 2022 | 55.1 | 56.5 |
| 2021 | 56.2 | 58.7 |
| 2020 | 57.2 | 59.6 |
| 2019 | § | § |
| 2018 | 54.8 | 55.6 |
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.
References
- S. Department of Health and Human Services (HHS). 2010. “Multiple Chronic Conditions: A Strategic Framework.” Retrieved January 26, 2017, from https://www.hhs.gov/sites/default/files/ash/initiatives/mcc/mcc_framework.pdf
- Centers for Medicare & Medicaid Services (CMS). 2014. “Multiple Chronic Conditions.” Retrieved January 11, 2017, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/MCC_Main.html
- Hastings, S.N., E.Z. Oddone, G. Fillenbaum, R.J. Sloane and K.E. Schmader. 2008. “Frequency and predictors of adverse health outcomes in older Medicare beneficiaries discharged from the emergency department.” Medical Care 46(8), 771–7.
- Aminzadeh, F., and W.B. Dalziel. 2002. “Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions.” Annals of Emergency Medicine 39(3), 238–47.
- Health Affairs. 2012. Health Policy Brief: Care Transitions. September 13, 2012. Retrieved July 12, 2016, from https://www.healthaffairs.org/do/10.1377/hpb20120913.327236/full/healthpolicybrief_76.pdf.