RT Journal Article
SR Electronic
T1 Connecting Emergency Department Patients to Primary Care
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 722
OP 732
DO 10.3122/jabfm.2015.06.150044
VO 28
IS 6
A1 Wexler, Randell
A1 Hefner, Jennifer L.
A1 Sieck, Cynthia
A1 Taylor, Christopher A.
A1 Lehman, Jennifer
A1 Panchal, Ashish R.
A1 Aldrich, Alison
A1 McAlearney, Ann Scheck
YR 2015
UL http://www.jabfm.org/content/28/6/722.abstract
AB 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 qualitative results provide insight into nonurgent ED utilization by patients with Medicaid, suggesting potential future interventions.