This set of case studies examines successful initiatives in three Aligning Forces for Quality communities that aim to reduce inappropriate emergency department use.

In Albuquerque, the New Mexico Coalition for Healthcare Quality (NMC4HQ) launched a campaign to educate patients about whether medical situations warrant a visit to an emergency department (ED) or an outpatient care facility. After the campaign, four local hospitals shared data and reported that non-emergency visits had dropped between 6 and 16 percent depending on the hospital, compared with the previous year—an average of 1,573 fewer non-emergency ED visits per hospital.

In Milwaukee, the Wisconsin Collaborative for Healthcare Quality (WCHQ) is leading an ED Care Coordination Initiative to connect high-risk patients in Milwaukee County with medical homes so they can receive timely, well-coordinated primary care. In 2012, the initiative scheduled more than 7,000 follow-up appointments for targeted patients. Forty-seven percent of patients kept these appointments, and roughly 46 percent returned for a second appointment within six months.

In Detroit, the Greater Detroit Area Health Council (GDAHC) leads a program in primary care practices to decrease ED use for primary care-treatable conditions. The initiative engages practices to reduce their patients’ avoidable ED use by implementing straightforward, “low-tech” interventions. Before the initiative, participating practices had increasing rates of ED use for PCP-treatable conditions, which peaked at 49 visits per 1,000 practice-affiliated Blue Care Network members in 2009. After the initiative began in 2010, rates decreased to 7.3 visits per 1,000.