Connecting hospital patients with community-based primary care: Outcomes and challenges from a seven year project at Massachusetts general and brigham and women's hospitals

As health care reform in Massachusetts has led to greater numbers of insured residents, the demand for primary care has grown. Primary care capacity at urban teaching hospitals is limited and not always cost effective, yet patients who present without a primary care provider need a way to engage in primary care. Two full-time coordinators educate patients on appropriate Emergency Department use; help patients understand their discharge instructions; promote the importance of having a regular primary care home; connect patients with a primary care provider at a community health center or other community practice; and schedule primary care appointments. Coordinators have helped over 5,400 patients engage in primary care. Comparisons of engaged patients with non-placed patients showed some declines in Emergency Department utilization and cost per Emergency Department visit post placement. Despite these positive trends, numerous challenges limit this project's success and have implications for the design of similar programs targeting broad patient audiences. • Many patients who are referred to the program insist on being assigned to a doctor at the teaching hospital and refuse assistance. • Capacity at community health centers and community practices does exist, but often isn't a match for the geographic location of the patient, or the patient is unwilling to go to the site where there is capacity. • Patient engagement has been a challenge, particularly among Emergency Department users who often don't see the need for a regular doctor.