Background: The disconnection between emergency departments (EDs) and outpatient care networks is a substantial contributor to ED over-crowding, inadequate transitions of care, and increasing healthcare expenditure in the United States. Thus, amidst increasing interest from multiple stakeholders, several studies have discussed the strategic integration of these siloed services as a potential answer to these systemic issues. Aim: This systematic review aims to synthesize the literature with regard to models of integration, outcomes measured, and factors related to the implementation of the integration of emergency care with primary and specialty care medical networks. Methods: Relevant literature was identified through a systematic search of peer-reviewed studies from 2000-2025 in PubMed, Scopus, Cochrane Library, and Web of Science. To be included, studies had to evaluate a formal integration strategy and report on outcomes (utilization, cost, patient satisfaction). Study design, population, intervention, and outcomes were extracted and synthesized narratively. Results: This review identified models of integration that work effectively, including embedded primary care clinics, patient navigation programs, tele-specialty consultations, and Geriatric EDs. In addition, there is strong evidence supporting that these models result in improvements. Aligning financial incentives, health information technology, and strong leadership are the most important facilitators for success. Fragmented payment models and interoperability issues are barriers. Conclusion: Incorporating emergency care with a broader care network collaboratively is an effective and essential strategy to improve patient outcomes, improve system efficiencies, and reduce costs. Successfully obtaining this at scale requires policy support to establish sustainable reimbursement models and an organizational commitment to the continued redesign of patient-centered care.
Alharbi et al. (Tue,) studied this question.