Discharge to medical home: A new care delivery model to treat non-urgent cases in a rural emergency department.

Emergency department visits for non-urgent reasons contribute to overcrowding and higher healthcare costs. Routing patients to lower cost care settings may improve outcomes. The Discharge to Medical Home model is a new care delivery model that routes low-acuity, ambulatory, emergency department (ED) patients to an adjacent primary care clinic, which provides the opportunity for patients to establish a medical home. During clinic hours, walk-in patients presenting to the ED are screened and, if appropriate, scheduled for a same-day appointment with a primary care provider. Over the first year of operation, the model reached 38% of all ED encounters and over 90% of daytime ED encounters. Over a third (36%) of daytime ED patients were discharged to primary care. Future steps include examining primary care follow up after initial discharge and examining models to best leverage the capacity of the primary care clinic to care for both walk-in and established patients.