Emergency Department Referral Process and Subsequent Use of Safety-Net Clinics.

We analyzed data on 10,761 low-income emergency department (ED) patients participating in the Emergency Department-Primary Care Connect program to identify successful methods of disseminating information on availability of primary care clinics. Data were obtained from all five hospitals in Montgomery County, Maryland, four participating county clinics, and from patient navigators. A two-part negative binomial model estimated factors associated with the probability of a clinic visit following a referral, and factors associated with the frequency of subsequent clinic visits. Twenty-one percent of patients had a subsequent clinic visit, and two-thirds of these patients returned for a second clinic visit. Patients were more likely to make the initial clinic visit if the referral was made by both the ED Provider and the patient navigator, relative to referral by the ED provider only. ED providers and patient navigators helped patients gain access to primary care services by referring them to safety-net clinics.

Lessons from the Arkansas Cash and Counseling program: how the experiences of diverse older consumers and their caregivers address family policy concerns.

This paper addresses four family policy questions that policy makers often ask about consumer-directed services, examining issues such as quality, suitability, and fraud and abuse. Responses to these questions evolved from the experiences of diverse elder consumers and their caregivers who participated in IndependentChoices, the Arkansas site of the Cash and Counseling Demonstration and Evaluation (CCDE) program. Building on CCDE evaluation survey data, this analysis of in-home interviews with participants discussing their experiences of receiving, giving, and managing care demonstrates how the program allows consumers choices so they receive the services they want. At the same time, program flexibility allows policy makers to safeguard both consumers and program resources through the use of supports such as representatives, state consultants, and fiscal intermediaries. This article demonstrates how the Cash and Counseling model can address the needs of both consumers with diverse disabilities and policy makers.