What Is Our Plan for Acute Unscheduled Care?
Authors: Keith E. Kocher, Brent R. Asplin
Journal: Annals of Internal Medicine (2013)

Ideas and Opinions18 June 2013What Is Our Plan for Acute Unscheduled Care?Keith E. Kocher, MD, MPH and Brent R. Asplin, MD, MPHKeith E. Kocher, MD, MPHFrom University of Michigan, Ann Arbor, Michigan, and Fairview Health Services, Minneapolis, Minnesota. and Brent R. Asplin, MD, MPHFrom University of Michigan, Ann Arbor, Michigan, and Fairview Health Services, Minneapolis, Minnesota.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-12-201306180-00008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Lost in the public debate over implementation of health care reform is a meaningful conversation about managing the challenge of acute unscheduled care—a responsibility that must be shared between primary and emergency care. Instead, the discussion to date offers a vision for what are essentially 2 silos of acute care delivery in the U.S. health system guided by competing agendas. One side stresses bolstering the patient-centered medical home and therefore primary care access to avoid emergency department (ED) visits (1), whereas the other side underscores the accessibility of ED care and the vital services provided (2).Nevertheless, the public is ...References1. Margolius D, Bodenheimer T. Redesigning after-hours primary care [Editorial]. Ann Intern Med. 2011;155:131-2. [PMID: 21768588] LinkGoogle Scholar2. Dresden SM. Measuring the value of the emergency department from the patient's perspective [Editorial]. Ann Emerg Med. 2013;61:324-5. [PMID: 23083966] CrossrefMedlineGoogle Scholar3. Pitts SR, Carrier ER, Rich EC, Kellermann AL. Where Americans get acute care: increasingly, it's not at their doctor's office. Health Aff (Millwood). 2010;29:1620-9. [PMID: 20820017] CrossrefMedlineGoogle Scholar4. National Center for Health Statistics. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2007. Hyattsville, MD: National Center for Health Statistics; 2010. Accessed at www.cdc.gov/nchs/ahcd/ahcd_reports.htm on 9 May 2013. Google Scholar5. Mehrotra A, Lave JR. Visits to retail clinics grew fourfold from 2007 to 2009, although their share of overall outpatient visits remains low. Health Aff (Millwood). 2012;31:2123-9. [PMID: 22895454] CrossrefMedlineGoogle Scholar6. Bodenheimer T, Pham HH. Primary care: current problems and proposed solutions. Health Aff (Millwood). 2010;29:799-805. [PMID: 20439864] CrossrefMedlineGoogle Scholar7. Bamezai A, Melnick G. Marginal cost of emergency department outpatient visits: an update using California data. Med Care. 2006;44:835-41. [PMID: 16932135] CrossrefMedlineGoogle Scholar8. Mehrotra A, Liu H, Adams JL, Wang MC, Lave JR, Thygeson NM, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med. 2009;151:321-8. [PMID: 19721020] LinkGoogle Scholar9. O'Malley AS. After-hours access to primary care practices linked with lower emergency department use and less unmet medical need. Health Aff (Millwood). 2013;32:175-83. [PMID: 23242631] CrossrefMedlineGoogle Scholar10. Agency for Healthcare Quality and Research. AHRQ Health Care Innovations Exchange: Innovations and Tools to Improve Quality and Reduce Disparities. Accessed at www.innovations.ahrq.gov/innovations_qualitytools.aspx on 22 April 2013. Google Scholar Author, Article, and Disclosure InformationAffiliations: From University of Michigan, Ann Arbor, Michigan, and Fairview Health Services, Minneapolis, Minnesota.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3036.Corresponding Author: Keith E. Kocher, MD, MPH, University of Michigan, Department of Emergency Medicine, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 152S, Ann Arbor, MI 48109-2800; e-mail, [email protected]edu.Current Author Addresses: Dr. Kocher: University of Michigan, Department of Emergency Medicine, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 152S, Ann Arbor, MI 48109-2800.Dr. Asplin: Fairview Health Services, 2450 Riverside Avenue, Corporate Office Building, Minneapolis, MN 55454.Author Contributions: Conception and design: K.E. Kocher, B.R. Asplin.Analysis and interpretation of the data: K.E. Kocher.Drafting of the article: K.E. Kocher, B.R. Asplin.Critical revision of the article for important intellectual content: K.E. Kocher, B.R. Asplin.Final approval of the article: K.E. Kocher, B.R. Asplin.Collection and assembly of data: K.E. Kocher. 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Dohn, MD, MSc 18 June 2013Volume 158, Issue 12Page: 907-909KeywordsEmergency medicineHealth careHealth care providersHealth care qualityHealth information technologyOutpatientsPatientsUpper respiratory tract infectionsUrinary tract infections ePublished: 18 June 2013 Issue Published: 18 June 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...