Faculty Bibliography

Background: Having a usual source of primary care is known to improve health. Currently only two-thirds of ED patients have a usual source of care outside the ED, far short of Healthy People 2020's target of 84%. Prior attempts to link ED patients with primary care have had mixed results. Objectives: To determine if an intervention directly linking low-acuity patients with a primary care clinic at the time of an ED visit could lead to future primary care linkage. Methods: DESIGN: Pseudo-randomized controlled trial. SETTING: Urban safety-net hospital. SUBJECTS: Adults presenting to the ED 1/07-1/08 for select problems a layperson would identify as low-acuity. Patients were excluded if they arrived by EMS, had a PCP outside our hospital, were febrile, or the triage nurse felt they needed ED care. Consecutive patients were enrolled weekday business hours when the primary care clinic was open. Patients were assigned to usual care in the ED if a provider was ready to see them before they had completed the baseline study survey. Otherwise they were offered the intervention if a clinic slot was available. INTERVENTION: Patients agreeing to the intervention were escorted to a primary care clinic in the same hospital building. They were assigned a personal physician and given an overview of clinic services. A patient navigator ensured patients received timely same-day care. Intervention group patients could refuse the intervention and instead remain in the ED for care. Both clinic and ED patients were given follow-up clinic appointments, or a phone number to call for one, as per usual provider practice. ANALYSIS: The main outcome measure was primary care linkage, defined as having one or more primary care clinic visits within a year of the index ED visit for patients with no prior PCP. Results: 1,292 patients were potentially eligible and 853 were enrolled (662 intervention and 191 controls). Groups had similar baseline characteristics. Nearly 75% in both groups had no prior PCP. Using an intention to treat analysis, 50.3% of intervention group patients with no prior PCP achieved successful linkage (95%CI 45.7-54.9%) vs. 36.9% of the control group (95%CI 28.9-45.4%). Conclusion: A point-of-care program offering low-acuity ED patients the opportunity to instead be seen at the hospital's primary care clinic resulted in increased future primary care linkage compared to standard ED referral practices