title: Effect of primary care referral on emergency department use: evaluation of a statewide Medicaid program.
abstract: OBJECTIVE
  Medicaid recipients without a regular source of care frequently use hospital emergency departments (EDs) for minor problems. This study examined whether referring Medicaid patients to primary care physicians and obstetricians results in a decrease in ED use and an increase in physician office visits.
  
  
  METHODS
  The statewide Voluntary Initiative Program (VIP), which referred Medicaid patients to primary care physicians and obstetricians without any managed care component, was examined. Claims data were reviewed for Medicaid clients 0-64 years old who obtained VIP referrals during the first five months of the program. The change in rate of visits to hospital EDs and physician offices was compared for the study group (n = 444) and for the state's overall Medicaid population (n = 40,860).
  
  
  RESULTS
  After referral, ED use decreased 24 percent for the VIP group and 4 percent for the Medicaid population. During the same period, physician office visits increased 50 percent for the VIP group but decreased 13 percent for the Medicaid population.
  
  
  CONCLUSIONS
  Even in the absence of managed care, referral to primary care physicians and obstetricians resulted in fewer ED visits and more physician office visits. These findings confirm the importance of primary care in improving the efficiency of health care delivery for the Medicaid population.
authors.forename: J M
authors.initials: JM
authors.lastname: Gill
authors.forename: J J
authors.initials: JJ
authors.lastname: Diamond
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003691:Delaware; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States