Chicago’s innovative plan to help deliver better medical care to its urban poor and decrease overall costs is proving more successful than critics originally anticipated. It sprung from the observation of University of Chicago Hospital’s executives that more than 40% of the over 55,000 patients who appear in its emergency room annually could be better and more efficiently served in a clinic or primary care physician’s office. The University of Chicago’s Urban Health Initiative was started in 2005 as a way to educate urban patients on when to use the emergency room and when to go to a clinic.
The program links each patient to a non-ER medical home where they can make appointments for non-emergency issues. The program was once led by Michelle Obama and has linked 5600 people to a medical home since it began. The idea behind finding patients a medical home is that redirecting non-emergency needs to a primary care physician or specialist at a clinic will result in higher-quality care for patients than they would receive at hospitals where costs are also much higher than at clinics. Decreasing the number of patients appearing unnecessarily for routine issues in emergency rooms will increase both cost-efficiency and quality of care.
Though these patients are not maintaining a consistent relationship with one doctor after they are referred by the University of Chicago to its directory of primary care providers, they are maintaining a closer relationship with a facility (their medical home) which helps target the national problem of those with chronic conditions not seeking preventive care. Increasing the rate at which these chronic conditions are addressed earlier and more consistently not only helps prevent premature deaths but also saves the healthcare system tens of billions of dollars. Though the problem of not seeking preventive care from a primary care doctor regularly is a national issue that transcends income groups, the problem is most severe in low-income neighborhoods such as those served by the Urban Health Initiative, where doctor’s appointments are low on the list of priorities.
The Urban Health Initiative has grown to include 24 community-based clinics and other providers and has a budget of over $6 million annually. The number of appointments made at clinics through program referrals have jumped nearly 40% to 3649 in the last year, compared to 2006. Critics point out however that in 2005 34% of patients (884 people) who were referred by the program kept their appointments at their medical home clinic. In 2010, that number has grown to 1386 patients – only 39% of all referrals.
Despite this criticism, the success of the program has been lauded nation-wide, to the point that the Urban Health Initiative is now poised to escalate research initiatives and teaching opportunities for physicians hopefully leading to its being a national model for medical care in urban areas.