Impact on an Urgent Care Clinic of a New Freestanding Emergency Department in a Resource-Scarce Area

Diana Hamer; Glenn N. Jones; Michael R. Loewe; Mandi W. Musso

doi:10.31486/toj.21.0146

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Figure.
Monthly visits to the urgent care clinic (UCC) and freestanding emergency department (FSED) by nonemergent and emergent classification.

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Table 1.

Demographic Characteristics of Patients Presenting to the Urgent Care Clinic and Freestanding Emergency Department

	Urgent Care Clinic
Variable	Before^a	After^a	P Value	Freestanding Emergency Department
Number of visits	63,483	72,610		26,458
Age, years, median (IQR)^b	36.1 (26.5-50.5)	35.1 (25.9-49.8)	<0.001	41.05 (29.3-56.2)
Race/ethnicity^c
White/Caucasian	5,126 (8.1)	4,502 (6.2)	<0.001	1,951 (7.4)
Black/African American	56,479 (89.0)	66,446 (91.5)		23,781 (89.9)
Hispanic	648 (1.0)	530 (0.7)		285 (1.1)
Asian	202 (0.3)	163 (0.2)		60 (0.2)
Other	1,028 (1.6)	969 (1.3)		381 (1.4)
Sex^c^,^d
Female	38,916 (61.3)	48,242 (66.4)	<0.001	15,355 (58.0)
Male	24,563 (38.7)	24,363 (33.6)		11,103 (42.0)
Insurance status^c
Private	9,186 (14.5)	9,414 (13)	<0.001	3,497 (13.2)
Medicaid	25,533 (40.2)	41,559 (57.2)		13,771 (52.0)
Medicare	5,204 (8.2)	8,920 (12.3)		5,245 (19.8)
Self-pay	23,560 (37.1)	12,717 (17.5)		3,945 (14.9)
Emergency department to hospital admission				3,387 (12.8)

↵^aBefore, 26 months before the opening of the freestanding emergency department (October 1, 2015, to November 15, 2017); After, 28 months after the opening of the freestanding emergency department (November 16, 2017, to March 1, 2020).
↵^bMann-Whitney U test comparing the independent distribution of nonparametrically distributed data.
↵^cChi-square test of independence.
↵^dTotal n for the Before column is 63,479. Total n for the After column is 72,605.
Notes: Data are presented as n (%) unless otherwise indicated. P<0.05 indicates statistical significance.
IQR, interquartile range.

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Table 2.

Mean Visits per Month, Emergency Department Outcomes, and AR(1) Model Estimations for Urgent Care Clinic Visits

Visit Classification/Outcome	Before,^a Mean Visits per Month	After,^a Mean Visits per Month	Estimate^b	Standard Error	t Test	P Value
Urgent care clinic visits
Total	2,441.65	1,910.78	–120.88	70.95	1.704	0.095
Nonemergent	1,603.38	1,739.32	91.81	60.34	1.521	0.134
Emergent	138.11	88.71	–48.37	3.70	–13.059	<0.001
Freestanding emergency department visits
Total		944.92
Nonemergent		477.07
Emergent		163.42
Freestanding emergency department outcomes
Discharge		823.96
Hospital admission		120.96

↵^aBefore, 26 months before the opening of the freestanding emergency department (October 1, 2015, to November 15, 2017); After, 28 months after the opening of the freestanding emergency department (November 16, 2017, to March 1, 2020).
↵^bDifference between the mean before the freestanding emergency department opening and the mean after the freestanding emergency department opening after adjusting for autocorrelation. A negative estimate indicates a decrease in visits between the 2 time periods, while a positive estimate indicates an increase.
Note: P<0.05 indicates statistical significance.

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Table 3.

Classification and Severity of Visits to the Freestanding Emergency Department by Urgent Care Clinic Status

	Urgent Care Clinic
Visit Classification/Severity	Open^a	Closed^a	P Value^b
Classification
Nonemergent	7,404 (46.8)	4,227 (55.6)	<0.001
Emergent	3,030 (19.1)	869 (11.4)	<0.001
Alcohol/drug	251 (1.6)	71 (0.9)	<0.001
Psychiatric	228 (1.4)	84 (1.1)	0.040
Injury	1,784 (11.3)	1,109 (14.6)	<0.001
Unclassified	3,139 (19.8)	1,249 (16.4)	<0.001
Emergency severity index
Immediate – 5	79 (0.5)	27 (0.4)	<0.001
Emergent – 4	2,218 (14.0)	431 (5.7)
Urgent – 3	12,393 (78.3)	3,476 (45.7)
Less urgent – 2	939 (5.9)	3,299 (43.4)
Nonurgent – 1	191 (1.2)	373 (4.9)

↵^aOpen, 7:00 AM to 12:00 AM; Closed, 12:00 AM to 7:00 AM.
↵^bChi-square test of independence for difference between visits during urgent care clinic open and closed hours by individual visit classification and overall emergency severity index.
Notes: Because 3,013 patients did not have a documented arrival time, their visits could not be included in the open vs closed analysis (n=23,445). Nineteen additional patients did not have a documented emergency severity index, so these patients were not included in the analysis (n=23,426). Data are presented as n (%). P<0.05 indicates statistical significance.

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Table 4.

Population, Census Block Groups, and Visits per 1,000 People to the Urgent Care Clinic and Freestanding Emergency Department Overall and by Area Deprivation Index

				Urgent Care Clinic
Variable	Adult Population, 2015	Adult Population, 2019	Census Block Groups	Before,^a Visits/Visits per 1,000 People	After,^a Visits/Visits per 1,000 People	P Value^b	Freestanding Emergency Department, Visits/Visits per 1,000 People
Catchment area	945,347	963,897	549	61,122 / 64.6	68,733 / 71.3	<0.001	25,444 / 26.4
Area Deprivation Index quintile^c
1st	220,349	236,837	108	3,301 / 15.0	2,894 / 12.2	<0.001	883 / 3.7
2nd	227,422	236,385	112	5,300 / 23.3	4,949 / 20.9	<0.001	1,634 / 6.9
3rd	186,541	186,653	109	7,904 / 42.4	8,229 / 44.1	0.013	2,663 / 14.3
4th	158,143	157,355	104	12,859 / 81.3	14,764 / 93.8	<0.001	5,117 / 32.5
5th	131,965	126,051	106	31,758 / 240.6	37,897 / 300.6	<0.001	15,147 / 120.2

↵^aBefore, 26 months before the opening of the freestanding emergency department (October 1, 2015, to November 15, 2017); After, 28 months after the opening of the freestanding emergency department (November 16, 2017, to March 1, 2020).
↵^bChi-square test of independence.
↵^cNo Area Deprivation Index score was available for 10 neighborhoods in the catchment area.
Note: P<0.05 indicates statistical significance.