| Description |
Background: Language concordance significantly impacts the continuity of care for new Americans and patients with low English proficiency (LEP) by affecting health literacy, patient education, and healthcare system navigation. These populations frequently use emergency departments (EDs) or urgent care (UC) facilities inappropriately due to healthcare system unfamiliarity and appointment scheduling challenges. Local Problem: Utah hosts over 85,000 refugees, with approximately 75% (n = 63,750) served by a large academic healthcare institution in Utah, yet only 10% (n = 6,000) are registered as established patients. Since 2019, daily patient volume at the affected clinic has doubled from approximately 50 to more than 100 patients, creating an urgent need for more efficient processes to improve continuity of care. This project aimed to increase successful primary care follow-up appointments for new Americans and LEP patients following UC visits. Methods: We used the Johns Hopkins Evidence-Based Practice Model and the Plan-Do-Study-Act (PDSA) framework, to conduct a 12-week mixed-methods analysis of clinic staff. Data collection assessed the frequency of interactions with target populations, primary care referral needs, common presentations requiring referral, and perceived barriers to successful follow-up. Weekly site visits and meetings with content experts facilitated rapid-cycle changes. Pre- and post-intervention surveys measured usability, feasibility, and satisfaction, and gathered recommendations for future applications. Interventions: We implemented a new standard practice flowchart at the affected clinic, where UC providers identified patients requiring primary care providers, while nurses, medical assistants, and patient registration staff facilitated immediate appointment scheduling before discharge. Results: Of 213 clinicians invited, 30 completed the pre-intervention survey, and 13 completed the post-intervention survey. Primary referral reasons included hypertension (20.3%) and type 2 diabetes mellitus (15.9%). Most participants rated the intervention as very usable (53.8%), very feasible (61.5%), and very sustainable (53.8%). Financial analysis revealed annual implementation costs of approximately $1,886, with projected net benefits ranging from $42,834 to $154,114 annually from reduced no-show-related losses. Conclusion: The intervention proved usable, feasible, sustainable, and cost-effective, with the potential to decrease revenue losses by up to $156,000 annually. Further evaluation is needed to assess the intervention's effectiveness in reducing the ‘no-show' rate and identify underlying barriers to workflow adherence to optimize implementation. |
