Clinica Esperanza/Hope Clinic, 60 Valley Street, Olneyville, Providence, RI, 02909, USA,
J Community Health. 2013 Dec;38(6):1042-9. doi: 10.1007/s10900-013-9712-y.
Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients' lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic's first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic's operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs.
每年，超过 900 万美国医院的急诊患者因非紧急医疗问题就诊，主要原因是患者无法获得初级保健医生的治疗。为避免因非紧急健康问题而不必要地使用昂贵的急诊室，在美国罗德岛州普罗维登斯一个低收入社区，在现有免费诊所的基础上增设了由护士管理的日间诊所（CHEER 诊所），为没有保险的患者提供一种方便、免费的医疗服务。对该诊所开业头 5 个月的情况进行了评估和成本效益分析。在试点期间，共诊治了 256 名患者。如果将提供的预防服务的质量调整生命年值纳入考量，预计可避免 128 万美元的未来医疗费用。将这些节省的成本除以诊所的运营成本，得出的平均投资回报率为每投资 1 美元可获得 34 美元的回报。在免费诊所增加护士管理的日间就诊时间，显著增加了无保险患者获得医疗服务的机会，对诊所和患者而言均具有成本效益。最终，在为无保险人群服务的社区诊所中复制这种模式，可以通过以低于急诊治疗相同问题的成本来治疗大量非紧急医疗问题，从而减轻急诊室的负担。
