Online Program

Evaluating Changes in Emergency Department following Initiative to Expand Primary Care

Tuesday, November 3, 2015 : 8:30 a.m. - 8:50 a.m.

Stewart Landers, JD MCP, John Snow, Inc., Boston, MA
Molly Higgins-Biddle, MPH, Health Services Division, JSI Research & Training Institute, Inc., Boston, MA
Ellen Freedman, MPH, Office of Community Benefits, Milford Regional Medical Center, Milford, MA
Background: A growing number of uninsured individuals without a primary care provider (PCP) were relying on the Emergency Department of Milford Regional Medical Center (MRMC) for their health care.  A coalition was formed to improve access to primary care for a growing underserved population resulting in the opening of a new community health center (CHC).

Methods: Immediately prior to and following the opening of new CHC, community health workers (CHWs) were hired to link patients from the MRMC Emergency Department (ED) without PCPs to the new CHC as well as to other existing sources of primary care.

Results: Patient volume in the ED remained relatively the same from April 1, 2013 to September 30, 2013 (visits=28,559, patients=21,302) prior to the opening of the CHC, to April 1, 2014 to September 30, 2014 (visits=29,267, patients=21,589) following the opening of the CHC.  Comparing ED patient characteristics, we found 1) a lower percentage of patient visits had NO PCP in 2014 (11%) compared to 2013 (18%), 2) a lower percentage of patient visits were ESI 4/Less Severe Diagnosis in 2014 (26%), compared to the comparable period in 2013 (29%) and 3) a lower percentage of patient visits had no insurance in 2014 (3%), compared to 2013 (5%). 

Conclusions: Opening a CHC and utilizing CHWs to link patients without primary care to new and existing PCPs resulted in reductions in rates of NO PCP among ED patients. A system-wide strategy implemented by a community coalition could effectively improve access to primary care.

Learning Areas:

Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Demonstrate methods used to assess changes in access to primary care. Identify effective strategies to increase access to primary care among underserved populations. Formulate effective evaluation plans for community health planning.

Keyword(s): Community Health Assessment, Emergency Medical Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in public health evaluation for 3 decades and am able to present on complex public health systems solutions and evaluation of those solutions.
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.