Web-based primary care referral program associated with reduced emergency department utilization

Background and Objectives: Uninsured patients without a primary care home tend to use the emergency department (ED) for primary care. We examined whether an enhanced scheduling system for follow-up care from the University of New Mexico Hospital Emergency Department (UNMH-ED) that assigns patients to a family medicine home can decrease ED utilization. Methods: The Community Access Program for Central New Mexico (CAP-NM) is a consortium of primary care safety net provider organizations. CAP-NM developed a HIPAA-compliant (Health Insurance Portability and Accountability Act), Web-based information system used by the UNMH-ED to refer uninsured, unassigned patients to family medicine practices ("homes") within the consortium. The Web site referral system operated 24 hours a day, 7 days a week; printed maps to clinic sites; and listed services offered. Analysis of quality assurance data compared (1) ED utilization outcomes of eligible patients referred by the CAP-NM Web site to a family medicine home to (2) outcomes of controls discharged from the ED in the usual manner. Results: The 756 patients referred to family medicine homes through the CAP-NM Web site demonstrated a significant 31% reduction in subsequent ED visits compared to controls. This reduction was most evident among those who had infrequent ED use before institution of the program. Conclusions: Implementing an enhanced referral system to family medicine homes from the ED is associated with decreased subsequent ED utilization by uninsured patients.