Online Program

Cheer project: Financial and QALY impact of emergency room diversion achieved by walk-in non-urgent care at a nurse-run clinic for the uninsured

Monday, November 4, 2013

Adam Silva, Clínica Esperanza Hope Clinic, Providence, RI
Lauren O'Loughlin, Clínica Esperanza Hope Clinic, Providence, RI
Farzana Kibria, Clínica Esperanza Hope Clinic, Providence, RI
Shayla Minteer, Department of Cell and Molecular Biology, University of Rhode Island, Middletown, RI
Alexandra Bicki, B.S., Clinica Esperanza Hope Clinic
Valerie Joseph, RN, BSN, Clinica Esperanza/Hope Clinic, Providence, RI
Ryan Handoko, Brown University, Providence, RI
Sheryl-vi Rico, Brown University, Providence, RI
Anne De Groot, M.D., GAIA Vaccine Foundation, Providence, RI
Millions of people use hospital emergency rooms (ERs) for non-urgent healthcare problems. While ERs provide physicians and exam rooms for this purpose, the cost of care may contribute to financial instability among the uninsured. We describe the development of a nurse- and volunteer-run walk-in clinic for non-urgent health problems, operating within a freestanding clinic for the uninsured in a low-income Providence neighborhood (CHEER Clinic at Clinica Esperanza/Hope Clinic). CHEER provides patients with easy access to health advice and treatment based on a set of clearly defined protocols and procedures in a nurse-run walk-in clinic. Trained student volunteers assist with paperwork, interpreting, and patient intake. A paper-based survey tracked patient satisfaction with care and types of services provided. The value of screening for health problems (e.g. blood pressure) was calculated using the National Commission on Prevention Priorities' information on quality-adjusted life years (QALYs) saved. From August 1 2012-December 31 2013 of CHEER clinic, 292 walk-in patients were evaluated and treated, and roughly $108,000 in potential ER cost was averted. Including the QALYs saved, CHEER clinic saved more than $1,000,000. Patient satisfaction with care was high (scoring 9/10 with 10 maximum). With few exceptions, all patient conditions were manageable by nursing protocols. Patients reported willingness to pay up to $20 for services. Replication of this non-urgent care nurse-run clinic model in other free clinic settings may expand access to appropriate treatment for uninsured patients, significantly reducing out-of-pocket costs, while also providing an opportunity to improve health outcomes for a hard-to-reach population.

Learning Areas:

Public health administration or related administration
Public health or related education
Public health or related laws, regulations, standards, or guidelines
Public health or related nursing
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Identify the need for intervention in emergency room usage for reduction of health care costs. List characteristics of frequent ER users and why they use the ED. Describe the care provided in a community walk-in clinic and in what ways it fills the needs of frequent ED users. Evaluate the cost effectiveness of a free community walk-in clinic for uninsured patients with non-urgent conditions.

Keyword(s): Access to Care, Cost-Effectiveness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a co-founder of a walk-in clinic servicing uninsured Rhode Island residents. The clinic has published the results of a previous evaluation in a journal for community health, of which I am a co-author. My public health interests are concerned with identifying barriers to health care access and developing replicable solutions that can increase potential long-term access to care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.