Assessing the longitudinal impact of a rural Federally Qualified Health Center on preventable uninsured Emergency Department visits

Background/Purpose: Rural and urban communities are experiencing a health care crisis due to over and inappropriate use of emergency departments (ED). Inappropriate use of the ED is inefficient and costly, and health centers have been shown to decrease the use of the ED for Ambulatory Care Sensitive Conditions (ACSC) that can be cared for in a primary health care setting. This is an extension of an initial study that assessed the impact of a rural Federally Qualified Community Health Center (FQHC) on uninsured ED visits prior to (2000) and after (2005) the center was established (2003). This study provides follow-up data for 2006 and 2007. Specifically assessed were FQHC program changes after 2005 and how the changes influenced ACSC uninsured ED visits.

Methods: Annual county hospital ED and FQHC data were analyzed and collected retrospectively from computer generated reports, 2000-2007. An algorithm was used to classify ACSC ED visits.

Results: The percent of the uninsured population visiting the ED dropped immediately the year the FQHC was established for Emergent-primary care treatable and non-emergent visits. There was no notable decrease for Emergent-ED care needed-preventable visits. Preliminary results of the raw data were similar for 2006 and 2007; final analysis will be complete the summer of 2009.

Conclusions: Results suggest the new interventions at the rural FQHC decreased the cost and number of ACSC uninsured ED visits. FQHCs have the potential to be a preventative strategy to decrease inappropriate uninsured ED visits.