Design of Community Health Partnerships for ED Referral Discharge to Primary Care from an Urban Hospital

Background: In an effort to control health care costs, increase health quality and to better manage the utilization of their facilities at the community level, emergency departments are being forced to design medical care delivery systems that include creating partnerships with local community health centers. Access to primary care appointments must be readily available and affordable in order for an active referral model to be successful.

Objective: To design and describe the results of the Caregiver Online Scheduling (COS) Model - an ED referral discharge process that provides patients with follow up appointments in a primary care clinic – either internal or external to the health system - prior to the patient leaving the ED in an urban hospital using two online scheduling programs.

Methods: Upon discharge, patients became part of an ongoing cohort when ED schedulers used two online scheduling systems to make follow-up primary clinic appointments. Internal health system appointments were tracked to demonstrate patients' utilization of the system. External health system appointments were tracked to determine to whom appointments were made.

Results: For eight months of implementation, the internal referrals resulted in commercial patients' ED utilization shifted downward by 19.6% and clinic utilization increased by 28.2%. This translated into over $277,000 of ED costs savings and over $258,000 in clinic revenue. During the same time period, there were 1099 external clinic appointments made to local community health clinics with a show rate of 30.3%. Although the show rate is low, compared to previous studies, this is rather high for ED to primary care referrals.

Conclusion: In order for an active referral model to be successful, access to primary care appointments must be readily available. Our ED took the responsibility to create working relationships with local health clinics to address the health care access needs of all of the patients upon discharge, irregardless of their payer type. Knowing that we couldn't serve all patients, we did educate all patients on the importance of care coordinated within a medical home and then the model used online scheduling to refer patients to quality medical homes where they can afford to establish long-term care relationships. This model has made a significant decrease in the number of patients that regularly access the ED to fulfill their primary care needs.