Assignment 1: Research Proposal

Research Question:

Does Providing Primary Care Services in an Urgent Primary Care Setting Lead to Decreased Inappropriate Use of Emergency Department Services for Non-Emergent Patients and Improved Patient Health Outcomes?

Concepts Being Studies

• The purpose of the Urgent [Primary] Care Centres is to see those patients in need of urgent care (non-life-threatening conditions) within 12-24 hours, but not requiring emergency care (BC Ministry of Health, 2017). The goal is to see them in a clinic-like setting but have access to lab and x-ray services as required and reduce the number of non-emergent patients in the emergency.
• Are there improved patient health outcomes based on the utilization of Urgent [Primary] Care Centres such as accessibility, services provided in a timely fashion?
• Do Urgent [Primary] Care Centres meet the immediate needs of the patients that are seen?
• The benefit to emergency departments through appropriate resource utilization.

Identify Main Categories to write about

• Increased accessibility to primary care services
• Reduced use of Emergency Department services for non-emergent services
• Improved patient health outcomes

Identify the theory or conceptual model

• Through a Descriptive - Quantitative Research Method, review available studies from the United States, Canada, United Kingdom, Germany, Italy, Australia, and the Netherlands; I plan to see what the financial benefits are to the Healthcare System of accessing the Urgent [Primary] Care Centres instead of Emergency Departments. Research information for these studies was collected through a standardized questionnaire that was completed by research experts (Baier, N., et al, 2017).
• Review the results of available satisfaction surveys of patients that have been treated in Urgent [Primary] Care Centres.

Identify search strategy/key words

• I have found 16 articles related to the research topic using Google Scholar, Cinahl, and AU Library. Key words I used in the search include primary, primary care, urgent, urgent care, cost, emergency, department, access, accessible, accessibility, insurance, Medicare, admission, care management, chronic disease management, ambulance, transition, pre-hospital, medical home, inpatient, transfer, nurse practitioner, chronic disease, ambulance, hospitalization, mental health, mental illness, family practitioners, emergency physician, physician, COPD, asthma, mental health.

A draft of thesis statement

• The purpose of this study is to assess the efficiency of Urgent [Primary] Care Centres (UPCC) in reducing the ER congestion for non-emergent patients, resulting in positive patient health outcomes. It is hypothesized that UPCC's will manage non-emergent patients efficiently, resulting in the appropriate use of emergency department resources and positive outcomes for patients.

References

Athabasca University. (2017). HADM 369: Health policy in Canada. Syllabus. Retrieved from: https://www.divisionsbc.ca/CMSMedia/Divisions/DivisionCatalog- vancouver/Primary%20Care%20Change/MinstryPapers_Combined.pdf

Baier, N., Geissler, A., Bech, M., Bernstein, D., Cowling, T., Jackson, T., van Manen, J., Rudkjøbing, A. and Quentin, W. (2017). Emergency and urgent care systems in Australia, Denmark, England, France, Germany and the Netherlands - Analyzing organization, payment and reforms. Health Policy, [online] 123(1), pp.1-10. Available at: https://www.sciencedirect.com/science/article/pii/S0168851018306390 [Accessed 24 Jan. 2019].

BC Ministry of Health. (2017). An integrated BC healthcare system that works for patients;health professionals; and sustainability. Retrieved from: https://www.divisionsbc.ca/CMSMedia/Divisions/DivisionCatalog- vancouver/Primary%20Care%20Change/MinstryPapers_Combined.pdf

Bruni, M.L., Mammi, I., Ugolini, C. (2016). Does the extension of primary care practice opening hours reduce the use of emergency services? Journal of Health Economics, (50), 144-155.

CIHI. (2017). Emergency department visits in 2014-2015. Retrieved from:https://secure.cihi.ca/free_products/NACRS_ED_QuickStats_Infosheet_2014-15_ENweb.pdf

Enard, K.R. & Ganelin, D.M. (2017). Exploring the value proposition of primary care for safety-net patients who utilize emergency departments to address unmet needs. Journal of Primary Care & Community Health (8)4. 285-293.

Glover, L. (2015). Australia: International Health Care System Profiles. Retrieved from https://international.commonwealthfund.org/countries/australia/

NHS. (2017). Urgent and emergency care services in England. Retrieved from: https://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/urgent-care-overview.aspx

Ohle, R., Ohle, M., Perry, J.J. (2017). Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study. Canadian Journal of Emergency Medicine, 19(4), 271-276.

Polit, D.F., & Beck, C.T. (2014). Essentials of nursing research: Appraising evidence for nursing practice (8th edition). Philadelphia: Wolters Kluwer Health /Lippincott Williams & Wilkins.

Shaw, E.K., Howard, J., Clark, E.C., Etz, R.S., Arya, R., Tallia, A.F. (2013). Decision-making processes of patients who use the emergency department for primary care needs. Journal of Health Care for the Poor and Underserved. (24). 1288-1305

Stafford, V., Greenhalgh, S., Davidson, I., (2013). Why do patients with simple mechanical backpain seek urgent care? Physiotherapy. V100. 66-72

UCAoA. (2018). Urgent care association of America. Retrieved from: https://www.ucaoa.org/

Villasenor, S. & Krouse, H.J. (2015). Can the use of urgent care clinics improve access to Care without undermining the continuity in primary care? Journal of the American Association of Nurse Practitioners. Vol 28 335-34

Weinick RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Aff (Millwood). 2010;29(9):1630-6.

Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology. Journal of Advanced Nursing 52(5), 546-553