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

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.