Quasi-Randomized Evaluation of the UCLA Next Day Clinic (NDC)

Launched by UNIVERSITY OF CALIFORNIA, LOS ANGELES · Jul 24, 2024

Keywords

ClinConnect Summary

The UCLA Next Day Clinic (NDC) is a new program designed to improve patient care for certain health conditions, like pneumonia and heart failure, by reducing unnecessary hospital stays. Starting July 22, 2024, the clinic will take patients who are identified in the emergency department (ED) as needing care but not requiring immediate hospitalization. Instead of being admitted to the hospital, these patients will be scheduled to visit the NDC the next day, allowing them to receive the right care without overcrowding the ED. This initiative aims to enhance patient safety and cost-effectiveness, and it will be evaluated by UCLA's healthcare experts to ensure its success and future growth.

To be eligible for this program, participants must be 18 years or older and identified in the ED as needing care for specific conditions. They should have insurance that covers follow-up at UCLA Health or be able to pay out-of-pocket. However, certain patients—like those with serious health issues or complex medical needs—will not be included. If selected, participants can expect to receive care at the NDC the day after their ED visit, which is intended to provide a more focused and less rushed treatment experience. Additionally, the clinic will only accept patients with even birth dates to ensure fairness in the selection process.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 18 years of age or older
• • About to be admitted through the ED for one of the NDC diagnoses or a synonym (per Study Protocol document), defined by the presence of a Plan to Admit order or Bed Request order, OR recently admitted under observation or inpatient status for one of the NDC diagnoses.
• • Identified as at-risk for an avoidable hospitalization in the ED based on a pre-determined set of lab and vital parameters.
• • Insurance that authorizes the patient to follow-up at UCLA Health, or self-pay
• • Admitted or being admitted to an internal medicine service
• Exclusion Criteria:
• • Heart or lung transplant recipient with concern for graft dysfunction
• • Pregnant
• • Enrolled in hospice
• • Resides in or discharged to a skilled nursing facility/acute rehabilitation facility
• • Admitted to a critical care service
• • ED deems discharge unsafe due to complex social or medical factors
• • Active malignant cancer (per Council of State and Territorial Epidemiologists value set)
• • Pulmonary arterial hypertension (per Joint Commission value set)
• • Undergoing workup for solid organ transplant
• • Interstitial lung disease (including pulmonary fibrosis) (per Higher Level 7 value set)
• • Requiring inpatient procedure or surgery defined by the presence of an anesthesia event or operating room encounter.
• • The ED deems discharge unsafe due to complex social or medical factors.
• • Transferred to an ineligible hospital
• Note:
• • The Health System plans to limit the volume of referrals to the NDC by only referring patients who have an even birth date (this is more equitable than first-come-first-serve, because wage workers are more likely to come to the ED later in the day; even/odd birth date theoretically keeps more spots open for patients presenting to the ED later).