Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov;134(11):1389-1395.e4.
doi: 10.1016/j.amjmed.2021.06.011. Epub 2021 Jul 17.

The Financial Impact of a Partnership Between an Academic Medical Center and a Free Clinic

Shelby Wallace  1 , Tricia J Johnson  2 , Emily Hendel  3 , Vidya Chakravarthy  4 , Lizette Leanos  5 , David A Ansell  6
Affiliations

The Financial Impact of a Partnership Between an Academic Medical Center and a Free Clinic

Shelby Wallace et al. Am J Med. 2021 Nov.

Abstract

Purpose: The objective of this study is to examine the association between an academic medical center and free clinic referral partnership and subsequent hospital utilization and costs for uninsured patients discharged from the academic medical center's emergency department (ED) or inpatient hospital.

Methods: This retrospective, cross-sectional study included 6014 uninsured patients age 18 and older who were discharged from the academic medical center's ED or inpatient hospital between July 2016 and June 2017 and were followed for 90 days in the organization's electronic medical record to identify the occurrence and cost of subsequent same-hospital ED visits and hospital admissions. The occurrence of any subsequent ED visits or hospital admissions and the cost of subsequent hospital care were compared by free clinic referral status after inverse probability of treatment weighting.

Results: Overall, 330 (5.5%) of uninsured patients were referred to the free clinic. Compared with patients referred to the free clinic, patients not referred had greater odds of any subsequent ED visits or hospital admissions within 90 days (odds ratio, 1.8; 95% confidence interval: 1.7-2.0). For patients with any subsequent ED visits or hospital admissions, the mean cost of care for those who were not referred to the free clinic was 2.3 times higher (95% confidence interval: 2.0-2.7) compared to referred patients.

Conclusion: An academic medical center-free clinic partnership for follow-up care after discharge from the ED or hospital admission is a promising approach for improving access to care for uninsured patients.

Keywords: Academic medical center; Academic medical center-free clinic partnership; Emergency department visits; Free clinic; Hospital costs; Hospitalizations; Uninsured patients.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: None.

Figures

Figure
Figure
Crude and weighted proportion of patients with any subsequent ED visits or hospital admissions within 90 days after index encounter discharge. Red line represents 95% CI of the weighted proportion with any subsequent ED visits or hospital admissions. CI = confidence interval; ED = emergency department.
See this image and copyright information in PMC

Similar articles

  • Does access to comprehensive outpatient care alter patterns of emergency department utilization among uninsured patients in East Baltimore?
    Block L, Ma S, Emerson M, Langley A, Torre Dde L, Noronha G. Block L, et al. J Prim Care Community Health. 2013 Apr 1;4(2):143-7. doi: 10.1177/2150131913477116. Epub 2013 Feb 20. J Prim Care Community Health. 2013. PMID: 23799723
  • Referral of medically uninsured emergency department patients to primary care.
    McCarthy ML, Hirshon JM, Ruggles RL, Docimo AB, Welinsky M, Bessman ES. McCarthy ML, et al. Acad Emerg Med. 2002 Jun;9(6):639-42. doi: 10.1111/j.1553-2712.2002.tb02305.x. Acad Emerg Med. 2002. PMID: 12045081
  • Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions.
    Carmel AS, Steel P, Tanouye R, Novikov A, Clark S, Sinha S, Tung J. Carmel AS, et al. West J Emerg Med. 2017 Aug;18(5):870-877. doi: 10.5811/westjem.2017.5.33593. Epub 2017 Jul 14. West J Emerg Med. 2017. PMID: 28874939 Free PMC article.
  • Overview of Emergency Department Visits in the United States, 2011.
    Weiss AJ, Wier LM, Stocks C, Blanchard J. Weiss AJ, et al. 2014 Jun. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb–. Statistical Brief #174. 2014 Jun. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb–. Statistical Brief #174. PMID: 25144109 Free Books & Documents. Review.
  • Administrative Support.
    Alcantara G, Chao NJ. Alcantara G, et al. 2021 Oct 29. In: Aljurf M, Majhail NS, Koh MBC, Kharfan-Dabaja MA, Chao NJ, editors. The Comprehensive Cancer Center: Development, Integration, and Implementation [Internet]. Cham (CH): Springer; 2022. Chapter 10. 2021 Oct 29. In: Aljurf M, Majhail NS, Koh MBC, Kharfan-Dabaja MA, Chao NJ, editors. The Comprehensive Cancer Center: Development, Integration, and Implementation [Internet]. Cham (CH): Springer; 2022. Chapter 10. PMID: 36122095 Free Books & Documents. Review.
See all similar articles

Cited by

References

    1. Tolbert J, Orgera K, Damico A. Key Facts About the Uninsured Population. Henry J Kaiser Family Foundation. Available at: https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-.... Accessed May 20, 2021.
    1. Kaufman A, Derksen D, McKernan S, et al. Managed care for uninsured patients at an academic health center: a case study. Acad Med 2000;75(4):323–30. - PubMed
    1. DeHaven M, Kitzman-Ulrich H, Gimpel N, et al. The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured. J Public Health 2012;34(4):577–83. - PubMed
    1. Abdullah F, Zhang Y, Lardaro T, et al. Analysis of 23 million US hospitalizations: Uninsured children have higher all-cause in-hospital mortality. J Public Health 2010;32(2):236–44. - PubMed
    1. Hadley J, Steinberg EP, Feder J. Comparison of uninsured and privately insured hospital patients. condition on admission, resource use, and outcome. JAMA 1991;265(3):374–9. - PubMed

MeSH terms