The Next Day Clinic (NDC) is a quality improvement initiative that will be launched and operated by UCLA Health starting July 22, 2024. Its goals are to improve patient care and safety and to maximize cost effectiveness. The way it does this is by identifying patients in the ED who would normally be admitted for low-acuity conditions, and diverting them to a high-acuity clinic the following day called the NDC. This will help decompress the ED and the hospital, and allow for overall higher quality care. The Health System has partnered with UCLA's Healthcare Value Analytics and Solutions \[UVAS\] group which specializes in these types of program evaluations. The analysis conducted by the study team will be used to directly inform NDC operations, scaling, and future plans.
NDC is a hospital avoidance model with the potential to simultaneously improve the quality and safety of acute care, reduce costs, and address hospital/ED overcrowding. This novel hospital avoidance program will divert patients from the ED who have been diagnosed with the following conditions and meet certain clinical criteria: * Diabetic Foot Infection/Osteomyelitis * Cellulitis * Congestive Heart Failure * Syncope * Pyelonephritis/Urinary Tract Infection * Pneumonia * Acute Kidney Infection
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
1,080
A dedicated Next Day Clinic team consisting of a clinician and nurse case manager will provide care and specialist referrals to patients within 24 hours of an ED visit that would have resulted in hospitalization without this novel hospital avoidance initiative.
Ronald Reagan UCLA Medical Center
Los Angeles, California, United States
Days alive and out of hospital (DAOH)
Cumulative number of days alive and not admitted or boarding in a hospital or emergency department
Time frame: 30 days from index ED visit
Global health-related quality of life
Composite PROMIS-29+2 score (patient reported outcome measurement information system). PROMIS stands for Patient-Reported Outcomes Measurement Information System. High scores mean more of the concept being measured.
Time frame: 30 days from index ED visit
Patient experience
Measured by PSQ-18 (patient satisfaction questionnaire). PSQ stands for Patient Satisfaction Questionnaire. High scores indicate higher levels of satisfaction.
Time frame: 30 days from index ED visit
Financial analysis
Total cost per day of treatment
Time frame: Through study completion, an average of 12 months
Cost effectiveness analysis
Total cost per day alive and out of hospital
Time frame: Through study completion, an average of 12 months
Hospitalizations avoided
Each NDC referral with a preceding Plan to Admit order or Bed Request order (regardless of treatment arm) will be considered an avoided hospitalization, given that the presence of one of these orders establishes that the counterfactual for NDC treatment in hospitalization.
Time frame: Through study completion, an average of 12 months
Hospital bed-days saved
For each referral to the NDC, the number of hospital bed-days saved will be established by using the mean length of stay for patients treated per-protocol in the control condition matched for the same presenting illness.
Time frame: Through study completion, an average of 12 months
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