Journal of Community Health

, Volume 38, Issue 6, pp 1042–1049

A Nurse-Run Walk-In Clinic: Cost-Effective Alternative to Non-urgent Emergency Department Use by the Uninsured

  • Alexandra Bicki
  • Adam Silva
  • Valerie Joseph
  • Ryan Handoko
  • Sheryl-vi Rico
  • Jacqueline Burns
  • Anna Simonelli
  • Jordan Harrop
  • Jennifer Nedow
  • Anne S. De Groot
Original Paper

DOI: 10.1007/s10900-013-9712-y

Cite this article as:
Bicki, A., Silva, A., Joseph, V. et al. J Community Health (2013) 38: 1042. doi:10.1007/s10900-013-9712-y

Abstract

Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients’ lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic’s first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic’s operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs.

Keywords

UninsuranceEmergency departmentFree clinicQALYHealthcare access

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Alexandra Bicki
    • 1
  • Adam Silva
    • 1
  • Valerie Joseph
    • 1
  • Ryan Handoko
    • 1
  • Sheryl-vi Rico
    • 1
  • Jacqueline Burns
    • 1
  • Anna Simonelli
    • 1
  • Jordan Harrop
    • 1
  • Jennifer Nedow
    • 1
  • Anne S. De Groot
    • 1
    • 2
    • 3
  1. 1.Clinica Esperanza/Hope ClinicOlneyville, ProvidenceUSA
  2. 2.University of Rhode IslandKingstonUSA
  3. 3.EpiVax, Inc.ProvidenceUSA