 Major burden on health system.  Costs about $ 15B annually.  Percentage occurrence ≈ 20%

Socio- demographic AgeSexRaceInsurance Marital Status Admissions History

Clinical Condition Type Comorbidity Index Medication

VariableP-Value Age.000 Urgent Condition.001 Neuroses.000 Congestive Heart Failure.027 Chronic Obstructive Pulmonary Disease.000 Dysponeas.000

Operational Cost Social Services Care Quality Discharge Alternative Services

Poor Access to Primary Care

Lack of equity in primary care distribution

Lengthy waiting times in primary care facilities

Survey: Many patients prefer receiving care from the ED rather than primary care. Why?

better access to alternative health services

Optimizing access to specialized clinics or centers for particular health conditions to provide better primary care (i.e. location, waiting time)

Better health care coordination and management

Patient choice of ED over primary care should be further investigated

Provide incentives for patients to seek primary care (e.g. Transportation)

Educate the patients about the readmission problem. “Hospitals are dangerous places”

financial incentives to primary care facilities to increase coordination and enhance care quality (A similar STAAR initiative for primary care)

Internal medicine physician with a similar role to the hospitalist could be employed in primary care facilities to enhance coordination and performance in the clinics

Patients favor primary care for follow-up rather than ED readmission

collaborative and multidisciplinary efforts from hospitals, primary care clinics, public health organizations, social services, and the government are crucial to the improvement of primary care utilization