Efficacy of a Free Clinic Utilized as a Transitional Clinic for the Uninsured: Outcomes on Chronic Disease Management and ED/Hospital Rates

Abstract

Objectives. To analyze the effectiveness of a novel system of transitional care to a medical home for uninsured populations living with chronic, uncontrolled diabetes. To quantify the impact of A1C management and healthcare maintenance on rates of hospitalization and/or emergency department visits due to disease complications. Methods. A retrospective chart review was performed, and patients were surveyed in Summer 2018 to determine current medical home status and what their last A1C was measured at after transitioning from the free clinic. The patient population selected included 38 patients who entered the transition process with a mean age 52 (±6.9 years). This group was made up of 14 men and 24 women. 16 total participants were fully transitioned to an FQHC (8 men and 8 women). Results. 50% successfully established care in a medical home. Established patients had an average initial A1C of 10.2%, time of transition A1C of 6.4% and post-transition A1C of 7.4%. Hospitalizations were reduced by 91% for all patients and Emergency Department visits was reduced by up to 79%. Conclusions. Transitioning to a medical home after achieving A1C control in a transitional clinic increased the likelihood of continued disease management and decreased the likelihood that they would require a higher level of care related to disease complications. Policy Implications: Medical homes may improve chronic disease outcomes for patients and healthcare systems.