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Peer-reviewedCC BY-NC-ND 4.0JAMA Network Open

Noninpatient Alternative Treatment Venues for Acute Care Needs

  • Dana R. Sax1,2,3
  • Dustin G. Mark1,2,3
  • Jie Huang2
  • Agnieszka E. Witkowski3,4
  • Priya Rao3,5
  • Hemali A. Sudhalkar3,5
  • Joeffrey R. Hatton3
  • Tambria M. Turco6
  • Shannon S. Maytum6
  • Vance E. Purcell6
  • Vivian E. Reyes3,7
  • Marina X. Dergun3,5
2 more authors
  • Brenda O. Oiyemhonlan-Sule1,3
  • Mary E. Reed2
7 affiliations
  1. 1Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California
  2. 2Kaiser Permanente Division of Research, Pleasanton, California
  3. 3The Permanente Medical Group, Pleasanton, California
  4. 4Kaiser Permanente Vallejo Medical Center, Vallejo, California
  5. 5Kaiser Permanente San Jose Medical Center, San Jose, California
  6. 6Kaiser Permanente Northern California, Pleasanton
  7. 7Department of Emergency Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California
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Abstract

Importance: Hospitalizations are costly and may lead to adverse events. Some health systems offer treatment in alternative venues of care for select patients.

Objective: To describe use and short-term outcomes of emergency department (ED) patients transitioned to noninpatient care settings (ambulatory treatment center [ATC], advanced care at home [ACAH], or emergency department observation unit [EDOU]) compared with inpatient care.

Design, Setting, and Participants: This retrospective cohort study of ED patients aged 19 years or older was conducted from January 1, 2024, to June 30, 2025, at multisite community ED and inpatient medical centers within an integrated delivery system (Kaiser Permanente Northern California). Included patients had active health plan membership; had an ED visit for heart failure, pneumonia, cellulitis, urinary tract infection, COVID-19, or anemia; and had their care transitioned to an ATC, ACAH program (Kaiser Permanente Advanced Care at Home), EDOU, or inpatient bed.

Exposure: Treatment venue.

Main Outcomes and Measures: The main outcomes were care escalation (inpatient admission) for patients treated in an ATC, ACAH program, or EDOU, as well as 7-day ED return visits, 30-day hospitalizations, and 30-day mortality following care completion across all venues. Unadjusted outcome rates are reported.

Results: This study included 26 618 ED encounters (median patient age, 77 years [IQR, 65-85 years]; 52.6% female). Among 22 755 unique patients, 87.4% had 1 encounter, 9.8% had 2 encounters, and 2.8% had more than 2 encounters. There were 728 (2.7%), 880 (3.3%), 5133 (19.3%), and 19 877 (74.7%) encounters in ATC, ACAH, EDOU, and hospital settings, respectively. One-quarter of patients (25.3%) received care in an ATC, ACAH program, or EDOU. Inpatient admission rates were lower for ATC and ACAH encounters than for EDOU encounters (4.3% [95% CI, 2.7%-5.8%], 5.3% [3.8%-6.8%], and 28.0% [26.8%-29.2%], respectively). Rates of 7-day ED visits were similar across venues (ATC: 10.4% [95% CI, 7.8%-12.9%]; ACAH: 5.3% [3.8%-6.8%]; EDOU: 9.2% [8.4%-10.0%]; and hospital: 8.5% [8.1%-8.9%]). In contrast, 30-day mortality and hospitalization rates were lower among ATC, ACAH, and EDOU encounters than in hospital encounters (30-day mortality: 2.1% [95% CI, 1.0%-3.2%], 1.7% [0.8%-2.6%], 2.8% [2.3%-3.2%], and 5.3% [5.0%-5.6%]; and 30-day hospitalization: 11.4% [95% CI, 8.8%-14.1%], 8.3% [6.3%-10.2%], 12.7% [11.7%-13.7%], and 15.3% [14.7%-15.8%], respectively).

Conclusions and Relevance: In this cohort study of patients treated in alternative venues of care, one-quarter received care in an ATC, ACAH program, or EDOU. These findings suggest that adoption of novel treatment spaces for appropriately selected patients may allow health systems to focus hospital resources on the patients with the most complex needs.

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Cite

BibTeXRIS
BibTeX
@article{sax2026noninpatient,
  title = {{Noninpatient Alternative Treatment Venues for Acute Care Needs}},
  author = {Dana R. Sax and Dustin G. Mark and Jie Huang and Agnieszka E. Witkowski and Priya Rao and Hemali A. Sudhalkar and Joeffrey R. Hatton and Tambria M. Turco and Shannon S. Maytum and Vance E. Purcell and Vivian E. Reyes and Marina X. Dergun and Brenda O. Oiyemhonlan-Sule and Mary E. Reed},
  journal = {JAMA Network Open},
  year = {2026},
  month = nov,
  doi = {10.1001/jamanetworkopen.2026.41859},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856228},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Noninpatient Alternative Treatment Venues for Acute Care Needs
AU  - Dana R. Sax
AU  - Dustin G. Mark
AU  - Jie Huang
AU  - Agnieszka E. Witkowski
AU  - Priya Rao
AU  - Hemali A. Sudhalkar
AU  - Joeffrey R. Hatton
AU  - Tambria M. Turco
AU  - Shannon S. Maytum
AU  - Vance E. Purcell
AU  - Vivian E. Reyes
AU  - Marina X. Dergun
AU  - Brenda O. Oiyemhonlan-Sule
AU  - Mary E. Reed
PY  - 2026
DA  - 2026/11/03
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.41859
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856228
AB  - Importance: Hospitalizations are costly and may lead to adverse events. Some health systems offer treatment in alternative venues of care for select patients.  Objective: To describe use and short-term outcomes of emergency department (ED) patients transitioned to noninpatient care settings (ambulatory treatment center [ATC], advanced care at home [ACAH], or emergency department observation unit [EDOU]) compared with inpatient care.  Design, Setting, and Participants: This retrospective cohort study of ED patients aged 19 years or older was conducted from January 1, 2024, to June 30, 2025, at multisite community ED and inpatient medical centers within an integrated delivery system (Kaiser Permanente Northern California). Included patients had active health plan membership; had an ED visit for heart failure, pneumonia, cellulitis, urinary tract infection, COVID-19, or anemia; and had their care transitioned to an ATC, ACAH program (Kaiser Permanente Advanced Care at Home), EDOU, or inpatient bed.  Exposure: Treatment venue.  Main Outcomes and Measures: The main outcomes were care escalation (inpatient admission) for patients treated in an ATC, ACAH program, or EDOU, as well as 7-day ED return visits, 30-day hospitalizations, and 30-day mortality following care completion across all venues. Unadjusted outcome rates are reported.  Results: This study included 26 618 ED encounters (median patient age, 77 years [IQR, 65-85 years]; 52.6% female). Among 22 755 unique patients, 87.4% had 1 encounter, 9.8% had 2 encounters, and 2.8% had more than 2 encounters. There were 728 (2.7%), 880 (3.3%), 5133 (19.3%), and 19 877 (74.7%) encounters in ATC, ACAH, EDOU, and hospital settings, respectively. One-quarter of patients (25.3%) received care in an ATC, ACAH program, or EDOU. Inpatient admission rates were lower for ATC and ACAH encounters than for EDOU encounters (4.3% [95% CI, 2.7%-5.8%], 5.3% [3.8%-6.8%], and 28.0% [26.8%-29.2%], respectively). Rates of 7-day ED visits were similar across venues (ATC: 10.4% [95% CI, 7.8%-12.9%]; ACAH: 5.3% [3.8%-6.8%]; EDOU: 9.2% [8.4%-10.0%]; and hospital: 8.5% [8.1%-8.9%]). In contrast, 30-day mortality and hospitalization rates were lower among ATC, ACAH, and EDOU encounters than in hospital encounters (30-day mortality: 2.1% [95% CI, 1.0%-3.2%], 1.7% [0.8%-2.6%], 2.8% [2.3%-3.2%], and 5.3% [5.0%-5.6%]; and 30-day hospitalization: 11.4% [95% CI, 8.8%-14.1%], 8.3% [6.3%-10.2%], 12.7% [11.7%-13.7%], and 15.3% [14.7%-15.8%], respectively).  Conclusions and Relevance: In this cohort study of patients treated in alternative venues of care, one-quarter received care in an ATC, ACAH program, or EDOU. These findings suggest that adoption of novel treatment spaces for appropriately selected patients may allow health systems to focus hospital resources on the patients with the most complex needs.
SN  - 2574-3805
ER  -