Evaluating Emergency Department Utilization among Undocumented Patients Receiving Care at a Community Health Clinic

Undocumented immigrants in the US rely on community health clinics (CHCs) and emergency departments (EDs) for preventive and acute care due to health insurance ineligibility and financial constraints. CHCs provide low-cost, accessible healthcare for thousands of undocumented immigrants in cities throughout the U.S. Limited evidence exists on this population's use of EDs despite establishing care in CHCs. This cross-sectional study described the key characteristics of ED visits among undocumented immigrants with established care at a single CHC in a major US city. ED visits (n = 319) were extracted using a random sample of patient records from a CHC serving a largely undocumented population between April 1, 2023, and April 1, 2024. The most common discharge diagnoses were categorized as infections (23%), injuries (22%), gastrointestinal diseases (16%), and OB/GYN diseases (11%). Disposition data showed that 81% of patients were discharged directly from the ED, 14% were admitted to the hospital, and 4% were placed under observation. For 309 visits, 61% were classified as preventable by the NYU ED algorithm (NYU-EDA). These findings suggest that most visits were preventable or primary care treatable, often driven by acute health issues rather than chronic care needs. Study results inform how CHCs, EDs, and health systems can address care gaps, enhance preventative care strategies, and advance equitable care delivery.