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Southside Medical Homes Network: Linking Emergency Department Patients to Community Care

Published online by Cambridge University Press:  17 February 2017

Amy L. Marr*
Affiliation:
University of Chicago Hospitals, Chicago, Illinois, USA
Tyson Pillow
Affiliation:
University of Chicago Hospitals, Chicago, Illinois, USA
Stephen Brown
Affiliation:
University of Chicago Hospitals, Chicago, Illinois, USA
*
Amy L. Marr, MD, Oregon Health and Science University, Department of Emergency Medicine, 1734 SW Moss Street, Portland, Oregon 97219 USA, E-mail: [email protected]

Abstract

Background: The 14 neighborhoods surrounding University of Chicago Hospitals (UCH) have both Chicago's highest “ambulatory-care-sensitive condition” hospitalization rates and lack of community-based care. To address these problems, in 2004, the Southside Medical Homes (SMH) Network began linking emergency department (ED) patients with 18 community providers. The ED-based patient navigator (patient advocate) is an integral component of this network, and both their current and developing roles will be discussed.

Methods: Six navigators worked in the UCH-ED approached eligible patients that are flagged by the ED electronic tracking system. Patients were offered the services provided by primary-care referral and appropriate dental, mental health, and substance abuse facilities. Appointments were scheduled, and pertinent ED medical data was faxed to the outlying sites. Navigator roles were expanding with SMH to include: (1) focus on frequent user/chronic disease populations such as sickle cell disease where advocates will expedite a multidisciplinary clinic referral; (2) navigator training to better inform patients of the specific benefits a “medical home” provides for preventive and psychosocial care; (3) and improving navigator, and secondarily, patient knowledge, of community resources: health-education sites, vocational programs, advocacy agencies, support groups, etc.

Results/Conclusions: Data through 01 July 2007 show a monthly average of 950 ED patients surveyed and 80% of these accepting follow-up referral services. Of those patients with ED-scheduled appointments (43%) in community clinics, network data shows patients returning to their referred providers: 39% of patients have been ≥2 times. The navigator role is evolving with the expansion of SMH to include: (1) frequent-user population referrals; (2) preventive health education; and (3) utilization of community resources.

Type
Brief Report
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

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References

1. Richardson, LD, Hwang, U: Access to care: A review of the emergency medicine literature. Acad Emerg Med 2001;8(11):10301036.CrossRefGoogle ScholarPubMed
2. Weinich, RM, Burstin, H: Monitoring the safety net: Data challenges for emergency departments Acad Emerg Med 2001;8(11):10191021.CrossRefGoogle Scholar
3. Chicago Department of Public Health: CAHI, Part 1: Demographic and Health Profiles. Chicago: CPDH, 2005.Google Scholar