TY - JOUR T1 - Reducing emergency admissions through community based interventions JF - BMJ Y1 - 2016 A1 - Wallace, E A1 - Smith, SM A1 - Fahey, T A1 - Roland, M AB - Reducing emergency admissions to hospital, both as a measure of care quality and to contain spiralling healthcare expenditure, is gathering interest internationally. Emergency admissions in the United Kingdom rose by 47% from 1998 to 2013, from 3.6 million to 5.3 million, with only a 10% increase in population over this period.1 These admissions are expensive; in 2012 they cost the NHS £12.5bn (€16.8bn; $18.3bn).1 Emergency admission is used as a performance measure for healthcare systems. One of the quality measures for accountable care organisations under the US Affordable Care Act2 is to reduce emergency admissions for three chronic medical conditions: chronic obstructive pulmonary disease (COPD), congestive heart failure, and asthma.3 UK policy makers took a step further and introduced a financial incentive for general practitioners to identify the 2% of their practice population at highest risk of emergency admission and to manage them proactively (case management). We discuss the uncertainties around identification, prevention, and management of patients at high risk of emergency admission and suggest alternative approaches. VL - 352 UR - http://www.bmj.com/content/352/bmj.h6817.long IS - h6817 ER -