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Faculty of Science, Chulalongkorn University
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Module 3 Assignment i
Student’s Name
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Course Number: Course Name
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Module 3 Assignment i:
The Impact of the Patient-Centered Care Model in Reducing Emergency Department
Visits Related to Chronic Health Conditions
Chronic illnesses, including diabetes, heart failure, and chronic obstructive pulmonary
disease (COPD), are significant drivers of the emergency department (ED) utilization rate. Such
visits are usually reflective of inadequate outpatient care coordination, inadequate self-care
activities, and inadequate patient-physician communication. Against this backdrop, the patient-
centered care (PCC) model has been developed as a novel nursing approach to managing chronic
illnesses. The PCC aims to enhance patient outcomes and decrease inappropriate emergency
department (ED) utilization by promoting individualized, collaborative, and participatory care.
This review presents the PCC nursing model as a means of reducing the frequency of emergency
department visits through enhanced self-management support, care coordination and continuity,
enhanced continuity and care coordination, and effective provider-patient communication, and
concludes with an analysis of trends, limitations, and gaps in the current evidence base.
Literature Review
While the patient-centered care model is understood as a means of providing care based on
the patient’s preferences, many may not acknowledge the role of such an approach in addressing
the growing cases of increasing emergency visits due to chronic health conditions. The PCC
nursing model provides a reliable framework for nurse practitioners to structure care that aligns
with clients' wants, needs, or preferences. Nonetheless, many healthcare professionals may not
understand that patient-centeredness should always be the overarching aim when developing
healthcare interventions. As reiterated by Edgman-Levitan and Schoenbaum (2021), health care
and health care systems primarily exist to improve individuals’ health and well-being. Therefore,
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even as nurses and other healthcare professionals seek to apply their medical knowledge and
clinical skills, the patient should be considered a co-partner in every move. The same concept
should apply to initiatives seeking to address the ever-growing cases of emergency visits by
patients with chronic health conditions. The PCC model can contribute to such endeavors in
multiple ways, as evidenced by available literature.
Self-Management Support and ED Reduction
Among the fundamental assumptions of the PCC model is facilitating patients' capacity to
care for their health independently. Chen et al. (2024) performed a randomized controlled trial
(RCT) evaluating an eHealth experiential learning program for patients with type 2 diabetes.
Members in the intervention group improved significantly in eHealth literacy, engagement, and
self-management activities compared to the control group. Although the study did not directly
measure ED visits, enhanced self-care of chronic diseases is proven to reduce acute care utilization.
These results suggest that digital education interventions with PCC alignments may indirectly
reduce ED demand.
In a complementary study targeting cancer patients, Mellerick et al. (2023) applied a nurse-
led emergency department avoidance model in a patient-centered approach. This quality
improvement initiative was aimed at cancer therapy patients in an ambulatory setting. The model
provided nurse triage, upfront symptom management, and individualized care planning, through
which avoidable ED visits were significantly decreased. While not an RCT, this study
demonstrates that incorporating nurse-implemented PCC interventions into routine outpatient
oncology practice can decrease the use of emergency services through direct intervention.
Together, these studies confirm the value of PCC-based interventions in strengthening chronic
disease management and preventing inappropriate ED use.
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Integration and Consistency of Healthcare Services
Adequate care coordination and continuity are also key PCC elements that prevent
fragmented care and over-reliance on emergency services. Garg et al. (2024) conducted a 12-
month RCT to determine the impact of telemedicine on chronic care delivery. Care continuity,
medication compliance, and, notably, fewer ED visits were observed in the intervention cohort.
This evidence supports telemedicine as a significant way of expanding PCC practices, especially
for individuals with mobility or transport problems.
As a comparison, Ryan et al. (2023) examined a large-scale multimorbidity-focused PCC
intervention in Ontario. The intervention included care coordination and frequent patient-provider
communication. Despite efforts, there was no statistically significant reduction in ED visits and
hospitalization relative to the control arm. Participants in the intervention did experience more
follow-up visits with primary care providers, which suggests improved access and continuity of
care. The heterogeneous findings may reflect differences in intervention intensity, population
complexity, or follow-up duration. The results highlight the need to optimize PCC models for
multimorbid populations, who may require more intense or prolonged interventions to impact ED
utilization.
Provider-Patient Relationship and Communication Continuity
Effective provider-patient communication—a key characteristic of PCC—has been
associated with greater adherence, trust, and reduced ED visits. Platonova et al. (2024) examined
this relationship in United States Medicaid beneficiaries. They found that patients with greater
communication with their primary care providers and longer-lasting relationships were
significantly less likely to have ED visits. These results emphasize the importance of continuity
and communication in the management of chronic disease. The ability to discuss problems freely
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and receive advice in a timely fashion reduces utilization of emergency services for issues that can
be managed in primary care.
However, this study raises a causality question in that those individuals who repeatedly
communicate with their healthcare providers might, at the same time, have high health literacy and
better self-care habits. Therefore, future randomized controlled trials should attempt to isolate the
quality of communication as an independent variable and test its independent effect on emergency
department use to validate this relationship.
Conclusion
The evidence aligns with the hypothesis that patient-centered care interventions can reduce
ED use by patients with chronic disease through enhanced self-management, continuity of care,
and effective communication by care providers and patients. The reviewed literature findings
indicate that PCC interventions—particularly those incorporating telemedicine, nurse triage, and
electronic health tools—can influence both patient behavior and system utilization. However, the
inconsistency in intervention design, target population, and outcomes measured limits
generalizability. Further research needs to emphasize long-term, standardized RCTs with direct
measurement of ED visits, especially in diverse and high-risk populations. When these gaps are
filled, healthcare systems can better leverage PCC models to reduce preventable ED visits and
improve chronic disease outcomes.
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References
Cheng, Y., Lin, C., Chen, L. A., Hwang, W., Lin, Y., & Chen, Y. (2024). Short-term effects of
an e-health care experiential learning program among patients with type 2 diabetes: A
randomized controlled trial (preprint). Journal of Medical Internet Research, 26, e53509.
[Link]
Edgman-Levitan, S., & Schoenbaum, S. C. (2021). Patient-centered care: Achieving higher
quality by designing care through the patient's eyes. Israel Journal of Health Policy
Research, 10(1), 21. [Link]
Garg, R., Walecha, A., Goyal, V., Mehra, A., Badkur, M., Gaur, R., Choudhary, I. S., & Talwar,
Y. (2024). A 12-month randomized controlled trial to assess the impact of telemedicine
on patient experience and care continuity. Cureus, 16(1), e53201.
[Link]
Mellerick, A., Akers, G., Tebbutt, N., Lane, T., Jarden, R., & Whitfield, K. (2023). Nurse-led
emergency department avoidance model of care for patients receiving cancer therapy in
the ambulatory setting: a health service improvement initiative. BMC Health Services
Research, 23(1). [Link]
Platonova, E., Ning, X., Pan, Y., & Thompson, M. E. (2024). Patient-centered primary care
provider communication and emergency room visits by Medicaid patients in the United
States. Journal of Patient Experience, 11. [Link]
Ryan, B. L., Mondor, L., Wodchis, W. P., Glazier, R. H., Meredith, L., Fortin, M., & Stewart, M.
(2023). Effect of a multimorbidity intervention on health care utilization and costs in
Ontario: Randomized controlled trial and propensity-matched analyses. CMAJ Open,
11(1), E45–E53. [Link]
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