The role of charity care and primary care physician assignment on ED use in homeless patients

Hao Wang, Vicki A. Nejtek, Dawn Zieger, Richard D. Robinson, Chet D. Schrader, Chase Phariss, Jocelyn Ku, Nestor R. Zenarosa

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective Homeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting. Methods A retrospective medical records review of homeless patients presenting to the ED and receiving treatment between July 2013 and June 2014 was completed. Appropriate vs inappropriate use of the ED was determined using the New York University ED Algorithm. The association between patients with charity care coverage, PCP assignment status, and appropriate vs inappropriate ED use was analyzed and compared. Results Following New York University ED Algorithm standards, 76% of all ED visits were deemed inappropriate with approximately 77% of homeless patients receiving charity care and 74% of patients with no insurance seeking noncrisis health care in the ED (P =.112). About 50% of inappropriate ED visits and 43.84% of appropriate ED visits occurred in patients with a PCP assignment (P =.019). Conclusions Both charity care homeless patients and those without insurance coverage tend to use the ED for noncrisis care resulting in high rates of inappropriate ED use. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED use in homeless patients.

Original languageEnglish
Pages (from-to)1006-1011
Number of pages6
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number8
DOIs
StatePublished - 1 Aug 2015

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Charities
Primary Care Physicians
Hospital Emergency Service
Insurance
Patient Care
Insurance Coverage
Vulnerable Populations
Ambulatory Care Facilities

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Wang, Hao ; Nejtek, Vicki A. ; Zieger, Dawn ; Robinson, Richard D. ; Schrader, Chet D. ; Phariss, Chase ; Ku, Jocelyn ; Zenarosa, Nestor R. / The role of charity care and primary care physician assignment on ED use in homeless patients. In: American Journal of Emergency Medicine. 2015 ; Vol. 33, No. 8. pp. 1006-1011.
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abstract = "Objective Homeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting. Methods A retrospective medical records review of homeless patients presenting to the ED and receiving treatment between July 2013 and June 2014 was completed. Appropriate vs inappropriate use of the ED was determined using the New York University ED Algorithm. The association between patients with charity care coverage, PCP assignment status, and appropriate vs inappropriate ED use was analyzed and compared. Results Following New York University ED Algorithm standards, 76{\%} of all ED visits were deemed inappropriate with approximately 77{\%} of homeless patients receiving charity care and 74{\%} of patients with no insurance seeking noncrisis health care in the ED (P =.112). About 50{\%} of inappropriate ED visits and 43.84{\%} of appropriate ED visits occurred in patients with a PCP assignment (P =.019). Conclusions Both charity care homeless patients and those without insurance coverage tend to use the ED for noncrisis care resulting in high rates of inappropriate ED use. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED use in homeless patients.",
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Wang, H, Nejtek, VA, Zieger, D, Robinson, RD, Schrader, CD, Phariss, C, Ku, J & Zenarosa, NR 2015, 'The role of charity care and primary care physician assignment on ED use in homeless patients', American Journal of Emergency Medicine, vol. 33, no. 8, pp. 1006-1011. https://doi.org/10.1016/j.ajem.2015.04.026

The role of charity care and primary care physician assignment on ED use in homeless patients. / Wang, Hao; Nejtek, Vicki A.; Zieger, Dawn; Robinson, Richard D.; Schrader, Chet D.; Phariss, Chase; Ku, Jocelyn; Zenarosa, Nestor R.

In: American Journal of Emergency Medicine, Vol. 33, No. 8, 01.08.2015, p. 1006-1011.

Research output: Contribution to journalArticle

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AU - Nejtek, Vicki A.

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AU - Ku, Jocelyn

AU - Zenarosa, Nestor R.

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N2 - Objective Homeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting. Methods A retrospective medical records review of homeless patients presenting to the ED and receiving treatment between July 2013 and June 2014 was completed. Appropriate vs inappropriate use of the ED was determined using the New York University ED Algorithm. The association between patients with charity care coverage, PCP assignment status, and appropriate vs inappropriate ED use was analyzed and compared. Results Following New York University ED Algorithm standards, 76% of all ED visits were deemed inappropriate with approximately 77% of homeless patients receiving charity care and 74% of patients with no insurance seeking noncrisis health care in the ED (P =.112). About 50% of inappropriate ED visits and 43.84% of appropriate ED visits occurred in patients with a PCP assignment (P =.019). Conclusions Both charity care homeless patients and those without insurance coverage tend to use the ED for noncrisis care resulting in high rates of inappropriate ED use. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED use in homeless patients.

AB - Objective Homeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting. Methods A retrospective medical records review of homeless patients presenting to the ED and receiving treatment between July 2013 and June 2014 was completed. Appropriate vs inappropriate use of the ED was determined using the New York University ED Algorithm. The association between patients with charity care coverage, PCP assignment status, and appropriate vs inappropriate ED use was analyzed and compared. Results Following New York University ED Algorithm standards, 76% of all ED visits were deemed inappropriate with approximately 77% of homeless patients receiving charity care and 74% of patients with no insurance seeking noncrisis health care in the ED (P =.112). About 50% of inappropriate ED visits and 43.84% of appropriate ED visits occurred in patients with a PCP assignment (P =.019). Conclusions Both charity care homeless patients and those without insurance coverage tend to use the ED for noncrisis care resulting in high rates of inappropriate ED use. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED use in homeless patients.

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