Scoping Review of Cost-Effectiveness of Emergency Department–Based Care Coordination Interventions

Care coordination is the organized management of patient care activities across healthcare participants and includes care planning, patient education, linkage to care, medication reconciliation, and resource referrals. This scoping review evaluates whether care coordination interventions initiated in the ED are cost-effective with respect to the reduction in preventable healthcare utilization and avoidable morbidity and mortality.

A literature search yielded a total of 13613 citations. All retrieved records were organized using EndNote V.20. After de-duplication, 13,568 citations underwent title/abstract screening; 415 underwent full-text review, and 143 were included for data extraction. For the 143 papers, the extraction focused on study design, intervention type, outcomes, and health-related social needs addressed by each intervention. A qualitative analysis was performed to understand the cost-effectiveness and associated health outcomes of the interventions.

Of the 143 studies, 38 reported cost-related outcomes; 18 of those studies included health or cost outcomes that were statistically significant. Interventions commonly addressed health-related social needs (n=16), post-ED treatment plans (n=15), information transfer to continuing care teams (n=11), education on continuing care (n=7), and incorporating data from previous visits (n=5). Overall, interventions were associated with positive financial outcomes, most commonly through reductions in acute care utilization, length of stay, and costs of care, such as through fewer laboratory tests. The remaining studies showed statistically significant improvements in treatment adherence; however, they did not show a strong positive financial impact. Positive healthcare quality improvement outcomes were categorized on health proxies, which included ED utilization (n=12), inpatient admission outcomes (n=9), and medication or treatment adherence outcomes (n=4).

Investing in ED-initiated care coordination interventions improves health outcomes while reducing avoidable health care costs. The majority of effective interventions addressed health-related social needs. Future studies would benefit from a standardized reporting structure for cost-effectiveness to support comparative analysis of ED-based care coordination interventions.