Emergency Department to Primary Care Medical Home Referral and Retention Project

Establishing a program to connect uninsured and underinsured patients with primary care medical homes in Milwaukee

Full Project Name:Emergency Department to Primary Care Medical Home Referral and Retention ProjectPrimary Community Organization:Milwaukee Health Care PartnershipPrimary Academic Partner:Eric Gass, PhD, Family and Community MedicineAward Amount:$372,285
Award Date
July2008
Project Duration:42 months

Project Description Narrative:


According to the Wisconsin Hospital Association, approximately 30% of all emergency department (ED) visits by uninsured and underinsured patients in selected Milwaukee hospitals were deemed non-emergent in 2006. Many low-income individuals use the ED for primary care purposes because they do not have access to a primary care "medical home." Those with chronic health conditions such as high blood pressure, diabetes, asthma, and mental health issues may have multiple ED encounters in a single year, and some seek care at several different emergency department for the same conditions. The use of the ED for primary care services results in episodic care, which is costly and results in poor health care outcomes as it does not afford continuity of patient care or appropriate disease management for people with chronic medical or behavioral health conditions.

According to surveys of ED staff and patient focus groups, many factors influence why, when, and where a patient seeks ED services over primary care, including the patient's perception of the seriousness of their condition, transportation oprtions, perceptions about the quality of non-emergency care settings, the time it takes to secure a primary care appointment, as well as their insurance status. To improve health outcomes and reduce costs, diverting non-emergent patients from EDs and linking them to primary medical homes is a key strategy.

Through this award, project partners will develop, implement, and evaluate an ED to Primary Care Medical Home Referral and Retention Project, aiming to divert uninsured and underinsured non-emergent patients from EDs and connect them with primary care medical homes to improve their access to quality, consistent health care.

Additional community partners:
Health Care for the Homeless of Milwaukee, Inc.; Milwaukee Health Services, Inc.; Westside Healthcare Association, Inc.

Additional MCW academic partner:
Marie Wolff, PhD, Family and Community Medicine

Outcomes & Lessons Learned:


• Developed, piloted, implemented and evaluated the referral, intake, and retention protocols between the partner emergency departments and federally qualified health centers (FQHCs)

• Hired intake coordinators for each participating FQHC to facilitate intake, retention, and outreach to patients

• Designed a protocol to reduce the number of non-emergent visits to area emergency rooms and increase the number of uninsured and underinsured patients connected with a medical home, partnering ED case managers and FQHC intake coordinators to identify patients for referral, and then connecting them with easy access to scheduling and follow-up

• Developed supporting materials, including a primary care referral form for ED use as well as an ED to Medical Home Implementation Toolkit that includes a standard document on the importance of a medical home for patient education in the ED

• Documented the referral of more than 8,000 patients from the ED to a community health center for the receipt of care and establishment of a medical home, increasing the average number of referrals during the pilot period from 78 at the start to 481 by completion. In addition, documented an increase in the percentage of patients who arrive for a scheduled appointment from 27% at project start to 42% at project completion, as well as the percentage of patients who returned to the clinic for more than one appointment at 60%

• Used results of pilot project to obtain support from participating health systems to fund and support the program after the grant period has ended

• Disseminated project results and findings at various meetings and events, and published project case study in the January 2011 edition of Healthcare Financial Management

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