Document Type

Article

Publication Date

7-2-2008

Abstract

Background: Currently, over 45 million people in the United States are uninsured. Many among the uninsured population are not established with a primary care provider and therefore utilize the Emergency Department (ED) for non-emergency concerns. Investigators have examined the impact a primary care referral has on subsequent ED utilization. At University of New Mexico Hospital (UNMH), Murnik et al asked if scheduling follow-up visits for uninsured patients using the ED to a primary care clinic would decrease subsequent ED utilization. The follow-up visits were scheduled using the Community Access Program for Central New Mexico (CAP-NM) a HIPAA compliant web-based system developed to share medical information from UNMH-ED and a consortium of six safety net community primary care clinics. Murnik et al results showed a 31% reduction of ED visits in referred patients compared to the control group. However, the number of clinic follow up visits for referred patients not was determined. Purpose: To determine the number of visits made to a primary care home by uninsured, unassigned patients referred from the emergency department. Methods: CAP-NM data base included 484 patients given a referral to primary care clinic between January 27, 2005 and November 30, 2005. The establishment of a primary care home' was defined as at least two visits within a two-year period. Referral counts were limited to those made from the UNMH Emergency Ward to one of the First Choice Community Healthcare clinics. Results: There were 203/484 (42%) of referred patients that made one or more First Choice visit in the two years following the CAP referral. Of the 203, 103 (50%) had one visit; 35 (17%) had two visits; 27 (13%) had three visits; 12 (6%) had 4 visits; 11 (5%) had 5 visits; 3 (1%) had 6 visits; 4 (2%) had 7 visits; 2 (1%) had 8 visits; 4 (2%) had 9 visits; 1 (0.5%) had 10 visits; 1 (0.5%) had 11 visits; and 1 (0.5%) had 13 visits. Therefore, there were 101 out of the 484 (21%) who had two or more visits, meeting the criteria of having established a 'medical home.' Conclusions: This study of the First Choice Community Healthcare Clinic shows that referral of uninsured patients from the emergency department to a primary care home results in only one fifth of patients establishing a medical home. Further research is needed to determine effective interventions to increase patients' establishing such a home.'

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