Guiding patients to more appropriate and less costly medical settings than emergency departments (ED) is a growing imperative. Unnecessary ED use — estimates are 35 to 40% — has been associated with limited access to primary care providers. Thus, increasing primary care resources can reduce rates of "avoidable" ED use and also enable patients to establish a regular, coordinated source of health care.

Responding to this set of issues in the Vallejo, California, area, health care and government leaders established the North Vallejo Patient Access Partnership "Right Care, Right Place" project in a community with few primary care resources and no county hospital. The project involved ED-related patient referrals between a not-for-profit hospital (Sutter Solano Medical Center [SSMC]) and a new federally qualified health center (FQHC) — La Clínica North Vallejo (LCNV) — to be located on the hospital's campus. As the project evolved, it focused on ED-to-FQHC referral following an ED visit. Other patients came to LCNV without a prior ED visit. A community consortium provided three-year project funding of more than $1.2 million for site renovation and operating costs.

An independent evaluation of the project was commissioned by the California HealthCare Foundation and conducted by the University of Southern California Center for Health Financing, Policy, and Management. Key outcomes from the 20-month evaluation study include:

• The project was highly successful in improving access to appropriate, affordable health care. By the end of 2009, LCNV was cited as their "medical home" by 95% of patient survey respondents.
• The project successfully directed patients to the FQHC. On average, 52 patients per month were guided from the hospital to LCNV. Referred patients were equally split between those treated in the ED and then referred to LCNV for follow-up visits and those who were referred through SSMC without an ED visit.
• There was modest to moderate impact on ED visits. Patient access to LCNV averted 4,600 ED visits over the study period. 
• The project had a positive economic impact on LCNV by reducing the number of low-paying or uninsured patients at the ED.
• Health care at LCNV cost three to four times lower than avoidable ED visits and five to eight times lower than ED visits that did not involve an inpatient admission.
• The project had distinctive local aspects, but offered insights transferrable to other communities, demonstrating that hospitals and FQHCs are well positioned to collaborate in offering innovative solutions to overuse of ED care.

Two documents, the full report by the USC Center for Health Financing, Policy, and Management presenting the evaluation's detailed findings, as well as a summary evaluation report from the California HealthCare Foundation, are available as Document Downloads.