Impact of a Student-Run Clinic on Emergency Department Utilization

Abstract

Background and Objectives: Student-run clinics (SRCs) provide primary care access to low-income patients who would otherwise pursue more expensive care, such as visits to emergency departments (ED). Decreasing inappropriate ED utilization offers an opportunity to create value in the health care system. However, to date, no SRC has rigorously studied this. This study examines whether increased access to ambulatory care through an SRC, the Crimson Care Collaborative (CCC), is associated with decreased ED utilization, providing value to payers and providers, and justifying investment in SRCs. Methods: We conducted a 5-year retrospective analysis of 796 patients to determine if ED utilization changed after patients enrolled in CCC. We used patient-level ED visit data to estimate the average change in ED utilization. A regression analysis examined the impact of demographic and clinical variables on changes in ED utilization. Results: Average per-patient ED utilization significantly (P<0.001) decreased by 23%, 50%, and 48% for patients enrolling in CCC from 2013 to 2015, respectively. Following enrollment in CCC, average ED utilization decreased by 0.39 visits per patient per year. This translates to 62.01 avoided ED visits annually, and estimated payer savings of $84,148, representing 68% of the clinic’s direct operating costs. Conclusions: CCC created value to payers and providers from 2013-2015 by providing a lower-cost source of care and increasing ED capacity for more emergent and appropriate care. This study suggests that SRCs can create financial value for both payers and providers while also providing an avenue to teach value-based care in medical education.

Multimorbidity Clustering of the Emergency Department Patient Flow: Impact Analysis of New Unscheduled Care Clinics

“…Previous studies investigating the impact of UCS have reported substantial reductions in "avoidable" ED visits, as well as cost reductions [11][12][13][14][15]. Using a questionnaire, Moe et al measured the impact of an after-hours clinic in terms of avoided ED visits and cost savings, and found that 36.8% of patients attending the after-hours clinic would otherwise have gone to the ED if the clinic had not been available [11].…”

“…While EDs can re-organize internal procedures to optimize patient flow and delivery of care [8,9], such changes do not stem the ever increasing tide of patients coming to the ED. Redirecting "avoidable" ED visits towards other healthcare services, notably Unscheduled Care Services (UCS), which are alternative clinics that can treat patients with low acuity conditions [10][11][12][13][14][15], is therefore one of the main responses proposed by current reforms [16,17].…”

“…To evaluate the impact of new UCS on demand for ED care, it is necessary to quantify patient inflow and characterise the dynamics of patient flow through the ED [18,19]. Most previous studies in this field have focused on a global evaluation of avoided ED visits and the resultant economical savings due the lower cost of UCS [10][11][12][13][14][15]. Segmentation of the complex patient flow using a classification of ED visits could help to characterize the nature of patient profiles avoided, and consequently, better understand temporal variations in ED attendance [20].…”

Pharmacy resident interventions and clinical progression in a student‐run free clinic

“…When these patients are managed appropriately in this setting, literature has shown that benefits include better care for the individual patient and potential cost avoidance for the health-care system at large. [2][3][4] An SRFC model also allows for interprofessional development when other medical specialties become involved. Pharmacy inclusion in the SRFC model offers benefits, such as opportunities to perform community service, educate medical students in pharmacology and pharmacotherapy, and improve patient care and outcomes.…”

Emergency Department Use Among Student-Run Free Clinic Patients: a Cross-sectional Study

“…Student-run free clinics (SRFCs) deliver care to patients frequently neglected by the health system. [1][2][3] Though SRFC use is associated with decreased ED utilization, 2,3 the drivers of ED use in SRFC patients are poorly described. This study aims to improve our understanding of why SRFC patients visit the ED and generate hypotheses to guide future interventions.…”