The patient is a 25-year-old African American male who came to the Bernard Mitchell Hospital emergency room for chest pain. He straightens his slouched posture and looks hopeful when Wanda Trice, an Urban Health Initiative patient advocate, pulls the curtain back and inquires about his medical home.
He doesn't have one, he tells her. In fact, the only time he sees a doctor is in the emergency room, even though he has health insurance. When Trice offers to arrange a visit to a University of Chicago-affiliated health clinic near his home, he eagerly asks to leave and go there, since he has been in the ER for hours.
No, you can't leave, Trice tells him. Clearly disappointed, he sighs and slouches again. But you can go there for follow-up care. Let me make you an appointment.
Patient advocates like Trice can play a vital role in helping patients find a medical home for routine care. Patients without medical homes often delay treatment for non-urgent medical conditions until the symptoms worsen and warrant a trip to the ER, where they may wait several hours to be treated.
One goal of the Urban Health Initiative is to change that pattern, connecting patients with medical homes through the South Side Healthcare Collaborative-UHI's network of community health centers.
About 74,000 patients pass through the Bernard Mitchell ER for adults and the pediatric ER at Comer Children's Hospital each year.
Each patient is screened by a triage nurse and later by a physician to determine the acuteness of the patient's condition. After triage, if a patient has a condition with low acuity, and he or she reports having no medical home, advocates like Trice begin the process of connecting the patient with a primary care physician at one of the health centers.
Eligible, low acuity patients who want to bypass the wait in the ER may be offered to receive care that same day at Friend Family Health Center, located three blocks north of the Medical Center. High acuity patients with no medical home are approached upon discharge after they have been thoroughly treated.
Recent data suggest that this approach is working. In early 2008, 40 percent of visits to the adult ER were classified as low-acuity, or non-life threatening. That number has dropped to 30 percent, according to data for fiscal year 2009.
I try to let them know that in the emergency room, you'll only be treated for your complaint that day, not for your overall health, explained Trice, who has been a patient advocate for four years. She has seen many patients come in for one condition and leave diagnosed with another that requires regular care. I try to let them know that [at a medical home] it's more personable. There will be time for questions and certain tests that just won't happen in the ER.
Through the South Side Healthcare Collaborative, the University of Chicago Medical Center has ties to more than 25 federally qualified community health centers throughout the city. Trice called the one closest to the young man's home, but the earliest available appointment conflicted with his work schedule. After more back-and forth-discussion, she scheduled an appointment for the young man one week later at Access Booker Family Health Center.
Advocates routinely follow-up with patients to check that they were satisfied with the clinic visit. The UCMC estimates that in both emergency rooms about 80 successful links are made each week, regardless of a patient's ability to pay. If a patient has challenges paying for services, the community health centers work with them by offering an income-based, sliding scale fee.
We don't leave our patients out there with no leads, and we don't want them to go clinic shopping, said Semeca Johnson, a patient advocate at Comer Children's Hospital. We do all the homework for patients to find them somewhere where they'll be comfortable.
Since helping to launch the patient advocate program at Comer, Johnson has seen more than 3,000 patients in two years. A large part of her job, she said, is educating parents. Johnson explains a child's medical condition and how it can best be managed at the doctor's office, rather than in the emergency room, and she explains the costs covered by insurance.
Patients often are able to get a quicker follow-up appointment at an affiliated clinic in the community, where many UCMC doctors attend patients. By helping patients find those options, advocates also help keep the ER available for patients who truly need emergency care.
Our goal is to get patients where they need to be, and a lot of times, that's not in the ER, Johnson said.
By Kadesha Thomas
