Effectiveness of a Nurse-Led Ambulatory Care Clinic in Reducing Emergency Department Visits and Hospitalizations.
4 affiliations
- 1University of Alabama at Birmingham, Department of Health Services Administration, School of Health Professions, Birmingham, Alabama.
- 2University of Alabama at Birmingham, Center for Outcomes and Effectiveness Research and Education, Birmingham, Alabama.
- 3University of Alabama at Birmingham, Department of Medicine, Birmingham, Alabama.
- 4University of Alabama at Birmingham Medicine, Birmingham, Alabama.
Abstract
Introduction
Gaps in care integration and coordination contribute to emergency department (ED) crowding and preventable hospitalizations, necessitating innovative solutions to improve care transitions and reduce acute care use. This study evaluates whether attendance at a nurse-led ambulatory intermediate care clinic (AICC) reduces three-month ED visits and hospitalizations compared to missed AICC appointments.Methods
This retrospective cohort study at a single academic center analyzed AICC appointments from the first three years of clinic operations using multivariable logistic regression models, controlling for demographic, socioeconomic, and clinical factors. Our primary outcome measure was an ED visit within three months of the AICC appointment; our secondary outcome measure was hospitalization within three months. Robustness was assessed using Poisson, negative binomial, and zero-inflated models.Results
Among 2,698 appointments analyzed (mean age 51.5 years; 49.7% female), patients who attended their AICC appointment had a lower absolute ED visit rate compared with those who missed it (250/2,389 [10.5%] vs 47/309 [15.2%]; risk difference, 4.75%; 95% CI, 0.56-8.93%; P = .03). Missing an AICC appointment was significantly associated with greater odds of an ED visit (OR, 1.54; 95% CI, 1.07-2.21; P = .02). Hospitalization rates were 47.3% versus 53.4% (P = .04), although missing an AICC appointment was not significantly associated with increased hospitalizations (OR, 1.28; 95% CI, 1.00-1.64; P = .05). Findings were consistent across robustness analyses.Conclusion
The ambulatory intermediate care clinic model was associated with fewer ED visits but not reduced hospitalizations, suggesting that intermediate care can improve timely access and address acute care needs but may be insufficient to influence more complex drivers of inpatient admissions. Future research should explore strategies to enhance coordination and optimize the role of intermediate care within broader health system workflows.
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BibTeX
@article{lee2026effectiveness,
title = {{Effectiveness of a Nurse-Led Ambulatory Care Clinic in Reducing Emergency Department Visits and Hospitalizations.}},
author = {Seung-Yup Lee and Reid M Eagleson and Larry R Hearld and Madeline J Gibson and Allyson G Hall and Michael J Mugavero and Greer Burkholder and Kimberly L Payne and William M Brown and Lauren M Epp and Laurie Hunter and Corey T Spraberry and Kristine R Hearld},
journal = {The western journal of emergency medicine},
year = {2026},
month = sep,
doi = {10.5811/westjem.53190},
url = {https://europepmc.org/article/MED/42900934},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effectiveness of a Nurse-Led Ambulatory Care Clinic in Reducing Emergency Department Visits and Hospitalizations.
AU - Seung-Yup Lee
AU - Reid M Eagleson
AU - Larry R Hearld
AU - Madeline J Gibson
AU - Allyson G Hall
AU - Michael J Mugavero
AU - Greer Burkholder
AU - Kimberly L Payne
AU - William M Brown
AU - Lauren M Epp
AU - Laurie Hunter
AU - Corey T Spraberry
AU - Kristine R Hearld
PY - 2026
DA - 2026/09/05
JO - The western journal of emergency medicine
DO - 10.5811/westjem.53190
UR - https://europepmc.org/article/MED/42900934
AB - Introduction Gaps in care integration and coordination contribute to emergency department (ED) crowding and preventable hospitalizations, necessitating innovative solutions to improve care transitions and reduce acute care use. This study evaluates whether attendance at a nurse-led ambulatory intermediate care clinic (AICC) reduces three-month ED visits and hospitalizations compared to missed AICC appointments.Methods This retrospective cohort study at a single academic center analyzed AICC appointments from the first three years of clinic operations using multivariable logistic regression models, controlling for demographic, socioeconomic, and clinical factors. Our primary outcome measure was an ED visit within three months of the AICC appointment; our secondary outcome measure was hospitalization within three months. Robustness was assessed using Poisson, negative binomial, and zero-inflated models.Results Among 2,698 appointments analyzed (mean age 51.5 years; 49.7% female), patients who attended their AICC appointment had a lower absolute ED visit rate compared with those who missed it (250/2,389 [10.5%] vs 47/309 [15.2%]; risk difference, 4.75%; 95% CI, 0.56-8.93%; P = .03). Missing an AICC appointment was significantly associated with greater odds of an ED visit (OR, 1.54; 95% CI, 1.07-2.21; P = .02). Hospitalization rates were 47.3% versus 53.4% (P = .04), although missing an AICC appointment was not significantly associated with increased hospitalizations (OR, 1.28; 95% CI, 1.00-1.64; P = .05). Findings were consistent across robustness analyses.Conclusion The ambulatory intermediate care clinic model was associated with fewer ED visits but not reduced hospitalizations, suggesting that intermediate care can improve timely access and address acute care needs but may be insufficient to influence more complex drivers of inpatient admissions. Future research should explore strategies to enhance coordination and optimize the role of intermediate care within broader health system workflows.
SN - 1936-900X
SN - 1936-9018
ER -