Use of HIT to Increase Primary Care Access in Medicaid Patients

The most frequent users of emergency department (ED) services are patients covered by Medicaid who use them for non-urgent or routine health services. This results in increased costs to health systems and society, and reduced quality of care. A common reason for inappropriate ED use by Medicaid patients is a lack of regular access to primary care physicians (PCPs), indicating a critical need for programs that can help direct patients to appropriate and accessible health care.

The goal of this project was to improve access to primary care for Medicaid patients and improve coordination of care across transitions in health care settings.

The specific aims of the project were as follows:

• Develop, implement, and evaluate an ED-PCP Connector program using a health information technology-based intervention to reduce ED utilization and increase primary care access for Medicaid patients who do not have a regular source of primary care. 
• Improve Medicaid patients’ satisfaction with care and improve communications between the ED and PCPs through use of an ED-PCP Connector program. 

A randomized controlled trial was used to evaluate the impact of the ED-PCP Connector program. Patients randomized to the intervention group were scheduled to follow up with a primary care physician of the patient’s preference as to location, date, and gender, and given a reminder card with directions to their chosen practice location. A message was then sent through the electronic medical record to the physician providing the patient’s name, medical record number, date and time of the scheduled appointment, and the reason for the ED visit. Patients randomized to the comparison group were asked to schedule their own appointment with a PCP, and given a handout to aid in selection and scheduling.

Twenty eight percent of patients in the intervention group and 13 percent in the comparison group attended at least one primary care visit within 3 months of their ED visit. While intervention patients were 2.5 times more likely to follow up with the primary care doctor, overall 62 percent of patients did not keep their appointments. Study participants indicated that they found the ED-PCP Connector program helpful for finding a PCP, scheduling an appointment, and developing a relationship with a physician. Common barriers to attending appointments included lack of transportation and childcare needs. Patients also frequently cited resolution of symptoms and a lack of a need for followup as causes for not keeping appointments. The researchers concluded that, although removal of system barriers is necessary to increase access to primary care for the Medicaid population, there is also a need to address socioeconomic barriers.