(B) Patient Focus Group--For the patients, the objective will be: (1) What was their general impression of the EDT; (2) did the EDT improve the ED discharge process for them; and (3) do they foresee any potential unintended problems of the EDT.
(C) Post-ED Care Providers Focus Group--For the post-ED care providers, the objectives are to determine: (1) How well the EDT has met the needs of these providers in caring for these patients; (2) how feasible it has been to properly care for patients for whom the EDT had been implemented; (3) if there are any unintended consequences of using the EDT. Post-ED care provider focus group members will be drawn from Johns Hopkins Community Physicians,
(5) Post Pilot Test In-depth Interviews--AHRQ will conduct semi-structured interviews with approximately eight individuals from each of the 3 stakeholder groups: EDT implementers, patients, and post-ED care providers. These individuals will provide feedback on issues surfaced during the focus groups. This will provide an opportunity to delve more deeply into specific topics of interest.
(6) Administrative and Observational Data--Quantitative outcome measures will come from an extraction of medical record data and direct observations performed by project RAs. Data will be extracted from hospital billing records and Electronic Medical Records (EMRs) and will include frequency of revisits, cost of 72-hour returns, cost of ED visits per 3 months and the cost of implementing the EDT. To calculate costs of program implementation, RAs will observe the time required by social work, case management, and nursing staff to implement the interventions prescribed in the tool. They will also keep a log of the materials given to the patients as part of the intervention. To evaluate the percentage of patients evaluated for assistance or placement, RAs will observe case managers/social workers during their interaction with the patients. To evaluate the percentage of follow-up phone calls, the RAs will keep a log of attempts and actual contacts. Since these data collections involve RA observations, or extractions from existing medical records performed by the RA, they pose no burden to the hospital or public and therefore are not included in the burden estimates in Exhibit 1.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden for the respondents' time to participate in this pilot test. The EDT will be pilot tested with a total of 1,200 patients (50 per week * 8 weeks * 3 sites = 1,200) and takes about 20 minutes per patient to complete. The one-month patient follow-up will be conducted with all 1,200 patients and will take 10 minutes to complete. The 3-month patient follow-up will be conducted with those patients identified as being uninsured and is estimated to take 5 minutes to complete.
Focus groups will be conducted with all three of the stakeholder groups (EDT implementers, patients, and post-ED care providers). There will be two groups held for the EDT implementers consisting of 8 persons each (16 total), and one group of 8 for both the patients and the post-ED care providers. Each focus group will last for 2 hours.
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