title: Connecting Emergency Department Patients to Primary Care.
abstract: BACKGROUND
  Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem because of cost. We developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients.
  
  
  METHODS
  Patients who presented to the ED without an identified primary care provider were randomized to the intervention (n = 72) or comparison group (n = 68) for a 12-month study designed to connect these patients to primary care offices. Evaluation was mixed quantitative/qualitative.
  
  
  RESULTS
  Significantly more intervention participants attended at least 1 primary care visit 3 months after the intervention (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.06-6.02), though this difference was not significant by 12 months (OR, 1.74; 95% CI, 0.79-3.84). The intervention participants also did not have lower odds of returning to the ED for nonurgent reasons by the 12-month follow-up (OR, 1.27; 95% CI, 0.65-2.48). Patient-reported barriers to attending a primary care appointment were primarily social and health system-related factors.
  
  
  CONCLUSIONS
  The intervention did not decrease ED visits nor increase primary care use over the 12 months of the study period. The qualitative results provide insight into nonurgent ED utilization by patients with Medicaid, suggesting potential future interventions.
authors.affiliation: From the Department of Family Medicine, College of Medicine (RW, JLH, CS, CAT, JL, AA, ASM), the School of Health and Rehabilitation Sciences (CAT), the Department of Emergency Medicine, College of Medicine (ARP), and the Division of Health Services Management and Policy, College of Public Health (ASM), The Ohio State University, Columbus. randy.wexler@osumc.edu.
authors.forename: Randell
authors.initials: R
authors.lastname: Wexler
authors.affiliation: From the Department of Family Medicine, College of Medicine (RW, JLH, CS, CAT, JL, AA, ASM), the School of Health and Rehabilitation Sciences (CAT), the Department of Emergency Medicine, College of Medicine (ARP), and the Division of Health Services Management and Policy, College of Public Health (ASM), The Ohio State University, Columbus.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hefner
authors.affiliation: From the Department of Family Medicine, College of Medicine (RW, JLH, CS, CAT, JL, AA, ASM), the School of Health and Rehabilitation Sciences (CAT), the Department of Emergency Medicine, College of Medicine (ARP), and the Division of Health Services Management and Policy, College of Public Health (ASM), The Ohio State University, Columbus.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Sieck
authors.affiliation: From the Department of Family Medicine, College of Medicine (RW, JLH, CS, CAT, JL, AA, ASM), the School of Health and Rehabilitation Sciences (CAT), the Department of Emergency Medicine, College of Medicine (ARP), and the Division of Health Services Management and Policy, College of Public Health (ASM), The Ohio State University, Columbus.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Taylor
authors.affiliation: From the Department of Family Medicine, College of Medicine (RW, JLH, CS, CAT, JL, AA, ASM), the School of Health and Rehabilitation Sciences (CAT), the Department of Emergency Medicine, College of Medicine (ARP), and the Division of Health Services Management and Policy, College of Public Health (ASM), The Ohio State University, Columbus.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lehman
authors.affiliation: From the Department of Family Medicine, College of Medicine (RW, JLH, CS, CAT, JL, AA, ASM), the School of Health and Rehabilitation Sciences (CAT), the Department of Emergency Medicine, College of Medicine (ARP), and the Division of Health Services Management and Policy, College of Public Health (ASM), The Ohio State University, Columbus.
authors.forename: Ashish R
authors.initials: AR
authors.lastname: Panchal
authors.affiliation: From the Department of Family Medicine, College of Medicine (RW, JLH, CS, CAT, JL, AA, ASM), the School of Health and Rehabilitation Sciences (CAT), the Department of Emergency Medicine, College of Medicine (ARP), and the Division of Health Services Management and Policy, College of Public Health (ASM), The Ohio State University, Columbus.
authors.forename: Alison
authors.initials: A
authors.lastname: Aldrich
authors.affiliation: From the Department of Family Medicine, College of Medicine (RW, JLH, CS, CAT, JL, AA, ASM), the School of Health and Rehabilitation Sciences (CAT), the Department of Emergency Medicine, College of Medicine (ARP), and the Division of Health Services Management and Policy, College of Public Health (ASM), The Ohio State University, Columbus.
authors.forename: Ann Scheck
authors.initials: AS
authors.lastname: McAlearney
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D063005:Health Information Systems; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: Medicaid; Primary Health Care