22 / 180
178
SUMMARY
California’s acute care system provides several essential
services and compares favorably with other developed
countries. For developing systems, a critical analysis of the
California model suggests: (1) ambulatory patients require
timely access to urgent and continuing primary care in
communities to allow the ED to focus on more essential
services; (2) outcomes from highly specialized care in
California support the wider consensus that time-sensitive,
life-threatening emergency conditions are best managed
within regionalized systems of care; (3) ED-oriented care
teams are well positioned to rapidly evaluate and treat
patients with acute exacerbations of chronic conditions,
reducing the need for more costly hospital admission or
readmission; (4) frequent visitors to ED’s due to poorly
controlled behavioral health require their own urgent
treatment pathways to preserve ED capacity.
Key words: Emergency departments, emergency care,
prehospital, emergency health, emergency psychiatric
services, patient centered care, continuity of patient
care, delivery of health care, integrated.
ACUTE CARE CONTINUUM IN CALIFORNIA
If California were a country rather than the largest of the
United States, its population would be slightly greater
than Canada. The World Bank and California Department
of Finance estimated that the state had the world’s sixth
largest gross domestic product in 2015. California has
advanced systems for acute care, yet has lower per capita
utilization of hospital-based emergency care than other
US regions, as well as other developed countries. Wider
understanding of the strengths and weaknesses of the
acute care continuum in California may be useful in other
population health settings.
DEMOGRAPHICS OF EMERGENCY CARE
Policy makers in most countries place a lower priority on
acute care than primary care, health screening, or popu-
lation surveillance. In many Commonwealth countries with
universal health insurance programs, overall emergency
department (ED) utilization remains higher than policy
makers might desire (see Table 1). In 2015, utilization in
Canada was 444 ED visits per thousand. In England, ED
utilization was 420 visits per thousand. In 2013, the most
recent year where federal data is available for all 50 states,
ED utilization in the US was similar at 423 ED visits per
thousand.
Global causes of high ED utilization include: inadequate
access to unscheduled ambulatory care, inadequate
primary care workforces, delays in specialized care due
to insufficient providers or payments, and geographic
barriers to care. Many developed countries also struggle
with aging populations with multiple chronic conditions
(MCC) (1,3). Acute care providers often face challenges
THE ACUTE CARE CONTINUUM IN
CALIFORNIA
WILLIAM WESLEY FIELDS MD FACEP (1) (2)
(1) Associate Clinical Professor, University of California at Irvine Medical Center.
(2) Department of Emergency Medicine, Kaweah Delta Medical Center.
Email:
wesfields@cep.comArtículo recibido: 14-12-2016
Artículo aprobado para publicación: 15-02-2017
[REV. MED. CLIN. CONDES - 2017; 28(2) 178-185]