A Nurse-Run Walk-In Clinic: Cost-Effective Alternative to Non-urgent Emergency Department Use by the Uninsured
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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.
KeywordsUninsurance Emergency department Free clinic QALY Healthcare access
The authors gratefully acknowledge Blue Cross & Blue Shield of Rhode Island for their visionary financial support of the pilot study, and Lauren Levitz for her careful review of the manuscript. The assistance of Reuben Hirsch is also gratefully acknowledged.
- 2.Centers for Disease Control and Prevention. (2013). National Hospital Ambulatory Medical Care Survey: 2010 emergency department summary tables. Retrieved from http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf.
- 5.Williams, K. A., & Buechner, J. S. (2006). Utilization of hospital emergency departments, Rhode Island, 2005. Medicine and Health/Rhode Island, 89(12), 415–416.Google Scholar
- 6.Buechner, J. S., & Williams, K. A. (2007). Classification of emergency department visits: How many are necessary? Medicine and Health/Rhode Island, 90, 96–97.Google Scholar
- 7.Sun, B. C., Hsia, R. Y., Weiss, R. E., et al. (2013). Effect of emergency department crowding on outcomes of admitted patients. Annals of Emergency Medicine, 61(6), 605–611.e6.Google Scholar
- 12.Adams, P. E., Martinez, M. E., Vickerie, J. L., & Kirzinger, W. K. (2011). Summary health statistics for the U.S. population: National Health Interview Survey, 2010. Vital Health Statistics, 10(251), 1–117.Google Scholar
- 13.Stephens, J., & Artiga, S. (2013). Key facts on health coverage for low-income immigrants today and under the Affordable Care Act. Retrieved from http://www.kff.org/uninsured/upload/8279-02.pdf.
- 16.U.S. Census Bureau. (2011). American Community Survey, American Community Survey 1-Year Estimates, Table S2701; generated by A. Bicki; using American FactFinder. http://factfinder2.census.gov (12 February 2013).
- 21.Program for uninsured saves $4.56 million. (2011). Hospital Case Management, 19(9), 134–139.Google Scholar
- 22.The Providence Plan. (2007). Providence neighborhood profiles: Olneyville. Retrieved from http://local.provplan.org/profiles/oln_main.html.
- 23.Agency for Healthcare Research and Quality. (2013). National guideline clearinghouse. Retrieved from http://www.guideline.gov.
- 24.California Correctional Health Care Services. (2012). Care guides/guidelines. Retrieved from http://www.cphcs.ca.gov/careguides.aspx.
- 25.Georgia Department of Public Health Office of Nursing. (2011). Nurse protocols for registered professional nurses in public health for 2012. Retrieved from http://www.health.state.ga.us/pdfs/nursing/Protocol%20Manual/2012/Full_Version-2012.pdf.
- 28.Senate Commission to Study Rhode Island Emergency Department Diversion. (2012). Findings and recommendations report submitted to the Rhode Island state senate, February 16, 2012. Retrieved from http://www.rilin.state.ri.us/Reports/Report%20overall.pdf.
- 29.U.S. Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic disparities: A nation free of disparities in health and health care. Washington, D.C.: U.S. Department of Health and Human Services.Google Scholar
- 30.U.S. Census Bureau. (2011). Overview of the uninsured in the United States: A summary of the 2011 Current Population Survey. Retrieved from http://aspe.hhs.gov/health/reports/2011/cpshealthins2011/ib.shtml.
- 31.Galewitz, P. (2012). Health care increasingly out of reach for millions of American. Retrieved from http://www.kaiserhealthnews.org/Stories/2012/May/07/health-affairs-care-increasingly-out-of-reach-for-millions.aspx.
- 34.Institute of Medicine. (2004). Insuring America’s health: Principles and recommendations. Washington, DC: The National Academies Press.Google Scholar
- 38.Tolley, G., Kenkel, D., & Fabian, R. (Eds.). (1994). Valuing health for policy: An economic approach. Chicago, IL: University of Chicago Press.Google Scholar