Implementation of an Acute Care Clinic Model to Improve Access to Care and Reduce Low Acuity Emergency Department Use

High utilization of the emergency department (ED) by older adults contributes to adverse health outcomes and increased cost of care. Studies have investigated interventions aimed at reducing low acuity ED visits, with increased primary care accessibility being among the most effective. This paper aims to describe the implementation of a novel acute care clinic model to improve same-day availability for urgent concerns within geriatric primary care.

We conducted a quasi-experimental difference-in-differences (DID) analysis to evaluate the impact of an Acute Care Clinic (ACC) model implemented within an outpatient geriatrics clinic between March 2022 and August 2023. Patient-level descriptive statistics were used to characterize ACC patients. Clinic-level outcomes were compared between geriatrics clinic patients (including ACC patients) and a reference group of patients who receive primary care at internal medicine clinics within the same health system using monthly aggregated data over a 24-month period (6 months pre- and 18 months post-intervention).

There were 1102 ACC visits (764 distinct patients) in the implementation period. ACC patients were more medically complex than both the geriatrics clinic overall and the reference group (average HCC score 2.4). Same-day labs were ordered in 34% of ACC visits and same-day imaging was ordered in 15% of ACC visits. Compared to the reference group, the geriatrics clinic showed a potentially greater reduction in calls escalated due to lack of same-day access (-3.1%; p = 0.08) and a larger increase in same-day scheduling (+2.8%; p = 0.13), though neither reached statistical significance.

An ACC model was successfully implemented within a geriatric primary care clinic and there was a trend toward improvement in same-day clinic access for these medically complex older adults. Further review of patient triage processes, financial impact, and patient satisfaction is needed for program evaluation, refinement, and expansion.