title: Referral of medically uninsured emergency department patients to primary care.
abstract: OBJECTIVE
  To examine the impact primary care referral has on subsequent emergency department (ED) utilization.
  
  
  METHODS
  Uninsured ED patients who reported not having a primary care (PC) provider were referred to PC services at a community health center (CHC). The number of CHC visits completed was documented and the utilization rates of hospital-based services (i.e., ED visits, outpatient clinic visits, and admissions) were compared for patients who completed a CHC visit and those who did not before and after referral.
  
  
  RESULTS
  Of the 655 referred patients, 22% completed at least one CHC visit. Patients who completed a visit were more likely to be older, to be female, and to have a chronic medical problem (p = 0.001). The number of visits to the CHC was significantly related to the payment method. Only 19% of those who were self-pay completed three or more CHC visits, compared with 63% of those who qualified for a sliding fee or insurance (p < 0.001). There was no significant difference in pre- or post-ED utilization between those who completed a CHC visit and those who did not. The only significant difference in utilization between the two study groups was for subsequent outpatient visits. Patients who completed a CHC visit were more likely to receive outpatient specialty care (23%) compared with patients who did not (12%) (p = 0.001).
  
  
  CONCLUSIONS
  For uninsured patients with no regular health care provider, improving access to primary care services is not enough to reduce their visits to the ED.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD 21205, USA. mmccarth@jhmi.edu
authors.forename: Melissa Lee
authors.initials: ML
authors.lastname: McCarthy
authors.forename: Jon Mark
authors.initials: JM
authors.lastname: Hirshon
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Ruggles
authors.forename: Anne Boland
authors.initials: AB
authors.lastname: Docimo
authors.forename: Melvin
authors.initials: M
authors.lastname: Welinsky
authors.forename: Edward S
authors.initials: ES
authors.lastname: Bessman
mesh_terms: D003153:Community Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*