Crossroad Health Center - OTR

Brad Pearson, Summer 2017

George Adly and I worked with Crossroad Health Center (CRHC) this summer at the Over-the-Rhine location. The project we worked on investigated the reasons that CRHC pediatric patients go to the emergency department (ED) at Cincinnati Children’s Hospital Medical Center (CCHMC) for non-urgent visits that could be avoided through the use of the Nurse Triage line and daily unfilled acute appointments at CRHC.

CCHMC sends CRHC monthly ED visit reports for pediatric patients whose primary care provider is one of CRHC’s physicians or nurse practitioners. We filtered these reports since April 19, 2017 and documented encounter urgency based on the 5-level triage scale. Patients who scored a 4 or 5, or had an urgent care visit and were not admitted to the hospital were enrolled in the study. Additionally, we recruited pediatric patients who had consulted acute care services at CRHC since April 19, 2017 as a positive control within our analysis.

We reached out to each patient’s parent/guardian (greater than or equal to 18 years of age) to administer a questionnaire focused on the ED encounter experience, the outcomes, and the reason why they chose the ED rather than CRHC. This information was gathered via phone call using CRHC landlines and questionnaire responses were recorded. Other information was collected from these patients’ Electronic Medical Record (EMR) at Crossroad, as well as from Epic Link, which provides Crossroad providers and clinical staff with a web-based real-time read only access to CCHMC’s Epic charts. The data collected was analyzed, de-identified, and saved on Crossroad’s private servers.

Trends in the variation of the following variables were assessed: age, gender, race, distance from Crossroad, distance from CCHMC, health insurance status, reason for visit to CCHMC Emergency Services, encounter experience, lab and diagnostic studies conducted at the CCHMC encounter, outcomes of the CCHMC visit, frequency of appointments at Crossroad, usage of acute-care services at Crossroad, and outside sources of health care. Ultimately, any variations in these variables were used to assess areas for improvement in the quality of pediatric acute care services provided by Crossroad. The aim was to understand what makes Crossroad pediatric patients use Emergency Services at CCHMC for non-urgent purposes instead of using the acute-care services offered at Crossroad. While our conclusions are still ongoing, we hope to continue our great work with Crossroad through 2018.