User Characteristics of a Low-Acuity Emergency Department Alternative for Low-Income Patients

Abstract

Introduction: Emergency department (ED) use for healthcare that can be treated elsewhere is costly to the healthcare system. However, convenience settings such as urgent care centers (UCC) are generally inaccessible to low-income patients. Housing an UCC within a federally qualified health center (FQHC UCC) provides an accessible convenience setting for low-income patients. In 2014 a FQHC UCC opened two blocks from an ED in the same health system. Our goal was to compare characteristics, access to care, and utilization preferences for FQHC UCC and low-acuity ED patients through retrospective chart review and prospective surveying. Methods: We completed a retrospective chart review of all patients from March 1, 2018-March 1, 2019, and compared characteristics of low-acuity ED patients (N = 3,911) and FQHC UCC patients (N = 12,571). We also surveyed FQHC UCC patients (N = 201) and low-acuity ED patients (N = 198) from January-July 2019. Results: Half of FQHC UCC patients had private insurance. Of ED patients, 29% were aware of the FQHC UCC. Both groups had similar rates of primary care providers. The most common reason for choosing the ED was perceived severity, and for choosing a FQHC UCC was speed. Conclusion: These findings show similarities and differences between these two patient populations. Future research is needed to determine utilization patterns and in-depth reasons behind them. Interventions that help patients decide where to go for low-acuity care may create more utilization efficiency. [West J Emerg Med. 2020;21(6)162-171.] of services than most primary care offices. 9 UCCs also tend to have much lower average costs ($168) 10 than the ED ($978-$2,259). 10,11 However, these convenience settings are a topic of debate regarding their ability to replace EDs for care. One study found that 13.7-27.1% of all ED visits could be treated at an UCC or retail clinic, which would result in a cost savings of approximately $4.4 billion per year. 12 Others argue that patients who are more likely to use the ED for low-acuity conditions have little access to other types of care, including convenience settings. 13 Convenience settings generally do not

Strength in the gap: A rapid review of principles and practices for urgent care centres

“…Presenting this information in the ED itself may have impact, 49 as patients may be unaware of nearby urgent care options and their suitability for relatively complex care. 50,51 Although patient profiles may vary between healthcare options, 10 it is recognized that patients presenting to the ED are often unable to effectively triage their concern 18,23,51 ; as such, efforts to facilitate appropriate decision-making should be made. 23 Community services like HealthLine, a provincial medical call centre, have been shown to positively affect patient urgent care decisions and therefore need to be both consulted and informed regarding UCCs.…”

Portrait of the Emergency Department at Orotta National Referral and Teaching Hospital in Asmara, Eritrea: A Prospective Observational Study

“… 18 High volumes of self-referred patients in SSA have been attributed to multiple factors including the absence of 24-hour access to primary care facilities/or limited access to other types of care, including convenience settings. 14 , 19 , 20 There is also a perception that one might have better access to expert consultation and therapeutic or diagnostic services during the day shift. 18 We believe that most of these factors may be operational in this setting.…”