New Study Documents Health Centers' Role in Cutting Emergency Department Use

Community health centers, or CHCs, may play a key role in reducing emergency department, or ED, visits among the uninsured. That's the conclusion of a study conducted by researchers at the National Center for Primary Care at the Morehouse School of Medicine in Atlanta and published in the Winter 2009 issue of The Journal of Rural Health.

The study looked at more than 2 million ED visits in 117 counties in rural Georgia from 2003 to 2005. It compared ED visit rates among uninsured patients in 93 counties without CHCs with those in 24 counties that had CHCs. The study found that uninsured patients accounted for 33 percent more ED visits in counties without CHCs than in counties with the health centers.

The results indicate that CHCs are a critical safety net for the uninsured and an effective means of reducing inappropriate ED use, according to George Rust, M.D., of Atlanta, the lead research author and director of the National Center for Primary Care at the Morehouse School of Medicine.

"If we invest in a community health center or other primary care medical homes for all the people who need them, we could substantially reduce inappropriate use of the emergency room," said Rust in an interview with AAFP News Now. "We also could make sure that people are getting more continuity of care and more appropriate care."

The study also found that one-third of the 2 million people who made a trip to an ED in the counties studied did not have health insurance, which means the uninsured are relying on EDs for their care because there is a lack of primary care, said Rust.

"When uninsured patients show up in the emergency room, it is often because that is the safety net for the safety net -- they have nowhere else to go," Rust said. "It creates a specific burden on rural hospitals in terms of their financial survivability, as well as additional issues of whether that is the appropriate place to get cared for because it crowds out other people with other kinds of emergencies."

The number of ED visits among uninsured patients in counties without a CHC totaled 615,789 between 2003 and 2005, compared with only 79,901 visits by uninsured patients living in counties with a CHC, according to the study. Counties without a CHC had 37 percent more ED visits for patients diagnosed with an ambulatory care-sensitive condition than counties with a CHC, and counties without a CHC recorded 32 percent more ED visits for chronic conditions such as diabetes and asthma, according to the study.

These types of chronic conditions could be more effectively managed in primary care settings, Rust noted.

The study did not gauge the economic impact of preventing ED visits. It did, however, cite a previous study that found that use of a CHC saved one local community nearly $14 million in hospital and patient costs during a 10-year period by decreasing the number of uninsured patients who visited the ED.

In addition, according to the Morehouse study authors, the National Association of Community Health Centers published a monograph (21-page PDF; About PDFs) in 2007 that suggested using CHCs could potentially result in a $4 billion reduction in ED visits nationwide.

The researchers plan to conduct a follow-up study to look at the economic impact of preventing ED visits in the Georgia counties studied, Rust said.

CHCs employ a team-based, physician-led model of care that provides the right care, in the right setting at the right time, thereby serving as a patient-centered medical home for the uninsured, according to Rust.

"We felt that we really needed to document the impact of these community health centers on providing a primary care medical home, and, in effect, the value of creating an appropriate safety net as opposed to having people relying on emergency rooms by default," said Rust.

The study's authors call for further research to "quantify the economic benefit attributable to the CHC-associated reduction in uninsured ED visit rates."