title: A nurse-run walk-in clinic: cost-effective alternative to non-urgent emergency department use by the uninsured.
abstract: Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients' lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic's first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic's operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs.
authors.affiliation: Clinica Esperanza/Hope Clinic, 60 Valley Street, Olneyville, Providence, RI, 02909, USA, albicki@gmail.com.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bicki
authors.forename: Adam
authors.initials: A
authors.lastname: Silva
authors.forename: Valerie
authors.initials: V
authors.lastname: Joseph
authors.forename: Ryan
authors.initials: R
authors.lastname: Handoko
authors.forename: Sheryl-vi
authors.initials: SV
authors.lastname: Rico
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Burns
authors.forename: Anna
authors.initials: A
authors.lastname: Simonelli
authors.forename: Jordan
authors.initials: J
authors.lastname: Harrop
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nedow
authors.forename: Anne S
authors.initials: AS
authors.lastname: De Groot
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics* / Q000458:organization & administration*; D003362:Cost-Benefit Analysis; D057286:Electronic Health Records; D005260:Female; D005382:Financing, Personal; D006297:Health Services Accessibility; D006300:Health Services Misuse / Q000517:prevention & control; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D019982:Organizational Case Studies; D057184:Practice Patterns, Nurses' / Q000191:economics* / Q000458:organization & administration; D011314:Preventive Health Services; D019057:Quality-Adjusted Life Years; D012237:Rhode Island; D011795:Surveys and Questionnaires