Using Health Information Technology (HIT), this proposal seeks to develop, implement, and evaluate an Emergency Department (ED)-Primary Care Provider (PCP) Connector Program that aims to: 1) improve access to primary care for Medicaid patients;and 2) improve coordination of care across transitions in healthcare settings. In a randomized controlled trial of this intervention, we will test whether the program makes a difference on the basis of both quantitative and qualitative assessments, including measures of ED utilization, assessments of patient satisfaction, and evaluations of physicians'opinions about the program's ability to improve communication between the ED and PCP settings. The Emergency Department (ED) is often used for non-urgent or routine health services adding considerably to healthcare expenditures. For patients covered by Medicaid, ED visits as a proportion of all ambulatory care visits are more than double the proportion for those with private insurance. It is necessary to determine how to encourage such patients to use primary care settings for their non-urgent and routine health services to reduce inappropriate ED usage. Our proposal is both timely and necessary. The recently passed Patient Protection and Affordable Care Act (PPACA) is projected to increase the number of patients receiving Medicaid coverage by a staggering 16 million. Given that the biggest users of ED services by far are those covered by Medicaid, there is clearly a need for programs that can help direct patients to appropriate, accessible, healthcare services. Although the PPACA provides insurance coverage it does not guarantee access to care, and access remains a critical issue for those patients who are covered by Medicaid.

Public Health Relevance

Patients who receive Medicaid coverage have reduced access to primary care and often have to resort to using the ED for non-urgent health care problems. The primary focus of this application is to improve access to primary care as well as improve communication between physicians during the patient transition period. Our approach utilizes existing HIT streamline the ED to primary referral process, as well as provide a safe means of real time communication between providers at different locations.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Exploratory/Developmental Grants (R21)
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Health Systems Research (HSR)
Program Officer
Grace, Erin
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Ohio State University
Family Medicine
Schools of Medicine
United States
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Wexler, Randell; Hefner, Jennifer L; Sieck, Cynthia et al. (2015) Connecting Emergency Department Patients to Primary Care. J Am Board Fam Med 28:722-32
Wexler, Randell K (2014) Invited letter: the evolving model of health care in the United States: system change is not enough. Adv Health Care Manag 16:173-6