title: Characteristics of the Frontier Extended Stay Clinic: a new facility model.
abstract: OBJECTIVE
  In 2004, 5 remote clinics--4 in rural frontier communities in Alaska and 1 in Washington--were funded to pilot and examine the effectiveness and appropriateness of a new facility model. Transporting patients from these locations to higher levels of care is not always possible requiring these facilities to expand their scope of services and provide care for extended periods. The Frontier Extended Stay Clinic (FESC) model is staffed and equipped to provide the combined services usually found in the separate settings of an outpatient primary-care clinic, inpatient acute care hospital and emergency room. This is a descriptive study of the characteristics of these pilot facilities and an analysis of patient utilization and outcomes.
  
  
  METHODS
  The 5 clinics collected outcome data for 2,226 extended-stay encounters of 4 hours or longer from 15 September 2005 to 14 September 2010. Data from these extended-stay encounters were summarized, and descriptive statistics were used to describe: number and duration of encounters, when the encounters started, chief compliant, discharge diagnoses, transfer destination, Medicare and Medicaid eligibility, and type of encounter.
  
  
  RESULTS
  From 2005 to 2010, the mean duration of an extended-stay encounter was 9.1 hours. All of the clinics experienced many extended-stay encounters that were initiated or continued after normal business hours. The 5 most frequent diagnoses at discharge for extended encounters were cardiovascular, gastrointestinal, injury, substance abuse and pneumonia/bronchitis. Almost half, 47.6%, of extended-stay encounters resulted in discharge of the patient without a need for either non-urgent follow-up referral or transport. Extended-stay encounters that ended in a patient being transported to another medical facility were 43.7% of the total. More than a quarter (26.9%) of extended-stay encounters were eligible for Medicare payment.
  
  
  CONCLUSIONS
  While many of communities can support a facility for primary care, there is an on-going need for facilities in remote frontier areas to also provide emergent and extended-stay care. The FESC can provide access to primary, emergent and extended-stay services in these locations.
authors: Institute of Social and Economic Research, University of Alaska Anchorage, AK 99508, USA. rrfrazier@alaska.edu
authors: Rosyland
authors: R
authors: Frazier
authors: Sanna
authors: S
authors: Doucette
mesh_terms: D000413:Alaska; D000554:Ambulatory Care Facilities / Q000458:organization & administration* / Q000706:statistics & numerical data*; D001110:Arctic Regions; D006301:Health Services Needs and Demand; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States; D014861:Washington
keywords: Frontier Extended Stay Clinic; access; emergency care; extended-stay encounter; health services delivery; rural health
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