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DATE & TIME: Tuesday, 8th December 2020, 1:00 pm (UK GMT)

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ABSTRACT: Hospital Emergency Departments (EDs) treat a substantive number of patients whose conditions could be managed in primary care. This can lead to ED crowding and suboptimal allocation of skills, which might in turn lead to poorer patient outcomes. In response, most English hospitals have integrated primary care physicians (GPs) within or alongside their EDs to improve matching of physician skills with patient needs, and to improve overall patient flow. In this study, we investigate the impact of GP availability in EDs upon a range of outcomes such as waiting times, unplanned reattendances following discharge from ED, and admission to a hospital bed.

We analyse all patients attending 40 EDs in England from April 2018 to March 2019. We employ two complementary methods to identify the impact of GPs in EDs, both exploiting variation in the hours of each day the GP service is available. First, we estimate two-way fixed effects models to compare patients attending EDs at the same time of day where some EDs have GPs present and other do not. Second, we employ a Regression Discontinuity Design (RDD) for each ED separately, using the start and end hour of GP availability as discontinuities.

Our results suggest that the presence of a GP has a very limited effect on a range of indicators of ED performance and outcomes. Despite a very large sample (4 million attendances), only unplanned reattendances was significantly affected (-0.3 percentage points) in our fixed effects models. Our RDD approach indicates substantial heterogeneity in response between EDs. This is, however, partly driven by variation in the timing of GP availability.

Our findings indicate that this particular change in skill-mix in EDs does not lead to measurable improvements in patient flow or outcomes.

James Gaughan, Research Fellow, Centre for Health Economics, University of YorkBIOGRAPHY: James Gaughan is a research fellow at the Centre for Health Economics. He joined the Health Policy team in October 2010. He holds a BSc in Economics and Finance as well as an MSc in Health Economics awarded by the University of York.

Current research, under the ESHCRU project, centres on the impact of long term care provision upon outcomes for hospital patients. This includes the determinants of hospital length of stay, patient discharge destination and delays in transfers of care. James has also been involved in research concerning the drivers of cost variation and the construction of reimbursement mechanisms for hospitals. This work draws on a combination of large complex datasets and the use of linked aggregated data.