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Out of the ER and into primary care: Bend project leads the way

Becky Wilkinson
Becky Wilkinson helps reduce unnecessary emergency room use in Bend.

Becky Wilkinson is neither a nurse nor a doctor, but she plays a key role in a successful Central Oregon effort to reduce wasteful, inappropriate use of hospital emergency rooms.

The project identifies so-called "frequent fliers" who visit the hospital at least 10 times a year, and, in a few cases, as often as once a week. Wilkinson, a community health worker based at St. Charles Medical Center in Bend, helps such patients connect with out-of-hospital primary care that meets their needs better and at much lower cost.

As a result, emergency room visits by 144 frequent users in the Bend area dropped by 49 percent during the first six months of this year. That's 541 fewer ER visits by that group alone, reducing costs by an average of more than $3,100 per patient.

The ER diversion project is perfectly aligned with Oregon health transformation's Triple Aim: better health, better care, lower costs. It frees up emergency medical staff to deal with true emergencies. It improves the health of patients with chronic illnesses such as asthma, diabetes and depression. And it brings down costs.

Nowhere else to turn

The project's first 144 patients had averaged 14 ER trips a year. The most common reasons included abdominal pain, headaches, vomiting and unspecified pain. Many had a history of emotional, physical or sexual trauma, and half had untreated behavioral health needs. A majority had no connection with a primary care provider that could help them avoid use of the ER.

"The ER was the only place for them to go," says Pat Kuratek, nurse director of HealthMatters of Central Oregon, which hired Wilkinson to work out of the St. Charles emergency department.

The project is a collaborative effort in Crook, Deschutes and Jefferson counties. It has 13 partners, including the St. Charles Health System, PacificSource Health Plans, HealthMatters and Mosaic Medical.

A helping hand

Wilkinson's job is not clinical. She's a connector, a navigator, a sounding board, a go-between.

"I tell them the goal is not to keep them out of the ER, but to get them better care," Wilkinson says. "Then I just let them talk, and I listen to their story."

Most are glad to join the project. More than 500 have enrolled.

"They're relieved," Wilkinson says. "They don't want to be going to the ER all the time."

Wilkinson's advice is nonjudgmental but direct. "A lot of it is just life skills": how to manage stress and reduce anxiety, how to keep appointments.

"If I can help them toward that small success — to give them a life skill they can use the rest of their lives and pass on to their kids — that's huge."

Editor's note: In November 2011, Wilkinson moved to Portland where she joined a similar project run by CareOregon.