A Case for Continuity of Care

Assistant Professor Jessica Castner, PhD, RN, is passionate about patient care and finding ways to improve the quality of care in our community to provide better patient outcomes. She and her UB colleagues, Sharon Hewner, PhD, RN, and Yow-Wu (Bill) Wu, PhD, are using data science to study emergency department (ED) utilization in those with behavioral health diagnoses.

As a former ED nurse, Castner is all too aware of the concept of ED “familiar faces” or “super users” – so named because they are frequently seen by the ED staff for their health care needs. Their recurrent visits do not just replace primary care, as has been commonly conjectured and frequently theorized; these individuals, in an effort to meet their complex health needs, are using the ED in conjunction with seeking care in all other forms, including primary care, specialized care and urgent care.

EDs have long been used as a safety net for the U.S. health care system. They are viewed as vital to public safety, providing both routine health care and emergency services to patients who rely on these visits to manage their frequent and complex health care needs. The researchers’ recent retrospective analysis utilizing 2009 Medicaid claims of work-aged adults (ages 18-64) from two Western New York (WNY) State counties revealed that psychiatric diagnoses, substance abuse and smoking are associated with frequent ED utilization for Medicaid recipients in all categories of underlying disease
complexity. There is a growing concern that ED utilization, especially in those with behavioral health diagnoses, provides less than ideal provider-patient relationship continuity, along with fragmentation and duplication of care. This, in turn, supports the growing demand to enhance both community and ED care and the capacity to support nurses in community-based prevention programs, as well as better co-morbidity screening for those seeking care.

The next steps for research include examining ED utilization for those with asthma in New York State (NYS) using the Statewide Planning and Research Cooperative System (SPARCS) database. This data will allow for a broader picture, as it consists of comprehensive, all payer data reporting and contains data across the entire lifespan for those included in the dataset. Castner is particularly interested in asthma because not only is there increased ED utilization by those with asthma diagnoses in NYS, there is also an increased prevalence of asthma in Erie County, according to the NYS Department of Health. This problem presents a local challenge to health resources in WNY, as well as the added difficulty of self-management and vigilance that is needed by asthma sufferers. For patients with mental health and substance abuse co-morbidities, this can present overwhelming obstacles to overcome as they try to navigate the complexities of the health care system.

- DONNA A. TYRPAK