Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2026
[Efficiency of streaming and integrated care models for low acuity patients in acute and emergency care-results from a prospective cohort study].
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Krüger Daniela, Wäscher Cornelia, Steinke Sylwia, Holzinger Felix, Winkler Hanna, Möckel Martin, Schmidt Konrad, Slagman Anna
Аннотация
INTRODUCTION: According to the emergency care reform, streaming low-acuity patients to outpatient care structures seeks to relieve emergency departments (EDs). The aim was to compare the care efficiency of different streaming models at the ED site.
METHODS: This prospective, multicenter cohort study compared three study arms in a primary-data cohort of low-acuity patients and a routine-data cohort of unselected patients: 1) a hospital-operated outpatient practice (hospital practice), 2) an on-call practice operated by the Association of Statutory Health Insurance Physicians (SHI practice), and 3) standard care with physician-assessed streaming potential. The primary endpoint was care efficiency: the proportion of patients directed to the alternative care structure or the assessed streaming potential. The secondary endpoint was patient safety (ED revisit, hospital admission).
RESULTS: Among low-acuity patients (primary-data cohort: n = 1096), care efficiency was 49.5% (n = 145) for the hospital practice and 77.2% (n = 322) for the SHI practice. The physician-assessed streaming potential was 73.4% (n = 240). Among unselected ED patients (routine-data cohort: n = 68.010), care efficiency was 11.4% (n = 2558) for the hospital practice and 29.9% (n = 13.668) for the SHI practice. An ED revisit within 30 days occurred in 2.1% (n = 1) after treatment in the hospital practice (no hospital admissions) and in 10.4% (n = 14) after treatment in the SHI practice (hospital admissions: 7.5%, n = 10).
DISCUSSION: The streaming and care of low-acuity patients at the ED site was more efficient in the SHI practice but was associated with potentially greater safety risks. Care efficiency in the primary-data cohort is likely overestimated due to recruitment, whereas the routine-data cohort provides more realistic estimates.
METHODS: This prospective, multicenter cohort study compared three study arms in a primary-data cohort of low-acuity patients and a routine-data cohort of unselected patients: 1) a hospital-operated outpatient practice (hospital practice), 2) an on-call practice operated by the Association of Statutory Health Insurance Physicians (SHI practice), and 3) standard care with physician-assessed streaming potential. The primary endpoint was care efficiency: the proportion of patients directed to the alternative care structure or the assessed streaming potential. The secondary endpoint was patient safety (ED revisit, hospital admission).
RESULTS: Among low-acuity patients (primary-data cohort: n = 1096), care efficiency was 49.5% (n = 145) for the hospital practice and 77.2% (n = 322) for the SHI practice. The physician-assessed streaming potential was 73.4% (n = 240). Among unselected ED patients (routine-data cohort: n = 68.010), care efficiency was 11.4% (n = 2558) for the hospital practice and 29.9% (n = 13.668) for the SHI practice. An ED revisit within 30 days occurred in 2.1% (n = 1) after treatment in the hospital practice (no hospital admissions) and in 10.4% (n = 14) after treatment in the SHI practice (hospital admissions: 7.5%, n = 10).
DISCUSSION: The streaming and care of low-acuity patients at the ED site was more efficient in the SHI practice but was associated with potentially greater safety risks. Care efficiency in the primary-data cohort is likely overestimated due to recruitment, whereas the routine-data cohort provides more realistic estimates.