An ED express care and community partnership model to improve ED efficiency and patient access

This study addresses the issue of the large number of patients using the ED for primary care needs through a CMS-funded demonstration project that pilot tested a partnership model between EDs and FQHCs to increase efficiency and capacity in these sites by identifying non-urgent patients in EDs at triage, providing express care services/prescriptions via advanced practice nurses, educating them on true emergencies vs. non-urgent needs and referring them to appropriate community sites for follow-up care and case management, thereby reducing volume of ED repeat users. Participating EDs in two pilot sites identified 8,700 patients with primary care needs during the two-year period, made follow-up appointments within one day through secure electronic scheduling system with FQHCs, which blocked appointments specifically for the ED referred patients, and forwarded patient information electronically. Partner FQHCs provided case management and other services to 7,600 referred patients, addressing their needs/barriers, linking them to intensive chronic disease management programs as needed, and serving as their medical home. EDs also identified 1,150 repeat users for intensive case management. The evaluation measures and outcomes included reduced hospital ED use for primary care services, increased capacity and patient volume within health centers and cost savings for hospitals and Medicaid. The study also examined factors related to patient barriers, summarized lessons learned from the model pilot test and recommended areas where policy changes or higher-level process changes may be needed to improve hospital efficiencies and primary care infrastructure or capacity. Plans are underway to market and expand this project model statewide.