Do public health clinics reduce rehospitalizations?: the urban diabetes study

Safety-net health clinics have been shown to reduce hospitalizations for ambulatory care-sensitive conditions. Their impact on rehospitalization after hospital discharge is unknown. We hypothesized that use of publicly-funded safety-net health clinics would reduce rates of rehospitalization among patients with diabetes. We expected this effect to be most evident among the most vulnerable patients. Linking data from the Philadelphia Health Care Centers (HCCs) with statewide hospital discharge data for 1994-2001 for patients with diabetes, we found that patients enrolled in the HCCs prior to hospitalization were rehospitalized 22% of the time, the same rate as other Philadelphians. Among those at higher risk of rehospitalization because pre-existing diabetes was not noted in hospital records, odds of rehospitalization were reduced by 24% for HCC patients. Given that patients in the HCCs are overwhelmingly poor and uninsured or underinsured, these findings suggest that access to primary care through the HCCs may have a protective effect against the poor health outcomes typically associated with lower socioeconomic status. Enrollment in publicly-funded safety-net health clinics may have prevented rehospitalizations for some vulnerable patients with diabetes.