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JAMA Performance Improvement
December 22/29, 2020

Caring for Emergency Department Patients With Complex Medical, Behavioral Health, and Social Needs

Author Affiliations
  • 1Family and Community Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco
  • 2Zuckerberg San Francisco General Hospital, San Francisco, California
  • 3Emergency Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco
JAMA. 2020;324(24):2550-2551. doi:10.1001/jama.2020.17017

An adult man presented to an emergency department (ED) with right leg cellulitis. He is experiencing homelessness, has schizophrenia, and injects heroin daily. Over the past month, he visited several EDs with chief concerns of leg pain, hunger, and a request for shelter. At each visit, he was prescribed antibiotics, instructed to elevate his extremity, and discharged to the encampment where he lives. He was unable to fill the prescriptions or elevate his leg, and his cellulitis continued but without fever or lymphangitis suggestive of systemic illness. At the current visit, the patient did not meet Centers for Medicare & Medicaid Services acute inpatient hospital admission criteria, which are used by hospitals and insurers to support billing for inpatient care. The patient’s insurance coverage has also lapsed.

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