Connect Care Project, Bridging the Gap Between Acute and Post-Acute Care

J Gen Intern Med. 2025 May 14. doi: 10.1007/s11606-025-09598-0. Online ahead of print.

ABSTRACT

BACKGROUND: Hospitals in the USA face increasing challenges with access and capacity, prompting strategies to optimize resources, enhance throughput, and improve patient care access.

OBJECTIVE: This study assesses the impact of an innovative clinic-based ambulatory service as an alternative to hospital-based outpatient care, including observation stays and emergency department (ED) follow-up.

SETTING AND PARTICIPANTS: A retrospective review of observation-status medical admissions from March 2020 to April 2023 at SUNY Upstate University Hospital. Patients presented to the SUNY Upstate ED.

PROGRAM DESCRIPTION: The Connect Care Project (CCP) introduced an ED-based hospitalist triage team and a hospitalist-led Connect Care (CC) clinic. The triage team identified ED patients needing expedited outpatient workup or close monitoring and follow up. Instead of hospital observation or ED follow up, these patients were referred to the CC clinic for needed workup, close monitoring, or follow-up.

PROGRAM EVALUATION AND RESULTS: Admissions under observation were compared 13 months before and after CCP implementation (November 2021). Chest pain, a common observation reason, was closely analyzed. Of 305,207 ED visits, observation admissions -especially for chest pain -significantly declined after CCP implementation.

DISCUSSION: The CCP model improved capacity, reduced cost, and streamlined patient flow. It is adaptable for broader implementation.

PMID:40369388 | DOI:10.1007/s11606-025-09598-0