Connecting Emergency Department Patients to Primary Care.

Wexler R1, Hefner JL2, Sieck C2, Taylor CA2, Lehman J2, Panchal AR2, Aldrich A2, McAlearney AS2.

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Abstract

BACKGROUND:

Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem because of cost. We developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients.

METHODS:

Patients who presented to the ED without an identified primary care provider were randomized to the intervention (n = 72) or comparison group (n = 68) for a 12-month study designed to connect these patients to primary care offices. Evaluation was mixed quantitative/qualitative.

RESULTS:

Significantly more intervention participants attended at least 1 primary care visit 3 months after the intervention (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.06-6.02), though this difference was not significant by 12 months (OR, 1.74; 95% CI, 0.79-3.84). The intervention participants also did not have lower odds of returning to the ED for nonurgent reasons by the 12-month follow-up (OR, 1.27; 95% CI, 0.65-2.48).Patient-reported barriers to attending a primary care appointment were primarily social and health system-related factors.

CONCLUSION:

The intervention did not decrease ED visits nor increase primary care use over the 12 months of the study period. The qualitativeresults provide insight into nonurgent ED utilization by patients with Medicaid, suggesting potential future interventions.