Original Article Early Return Visits by Primary Care Patients: A Retail Nurse Practitioner Clinic Versus Standard Medical Office Care James E. Rohrer, PhD, Kurt B. Angstman, MD, and Gregory Garrison, MD Abstract The purpose of this study was to compare return visits made by patients within 2 weeks after using retail nurse practitioner clinics to return visits made by similar patients after using standard medical office clinics. Retail medicine clinics have become widely available. However, their impact on return visit rates compared to standard medical office visits for similar patients has not been extensively studied. Electronic medical records of adult primary care patients seen in a large group practice in Minnesota in 2009 were analyzed for this study. Patients who were treated for sinusitis were selected. Two groups of patients were studied: those who used one of 2 retail walk-in clinics staffed by nurse practitioners and a comparison group who used one of 4 regular office clinics. The dependent variable was a return office visit to any site within 2 weeks. Multiple logistic regression analysis was used to adjust for case-mix differences between groups. Unadjusted odds of return visits were lower for retail clinic patients than for standard office care patients. After adjustment for case mix, patients with more outpatient visits in the previous 6 months had higher odds of return visits within 2 weeks (2–6 prior visits: odds ratio [OR] = 1.99, p = 0.00; 6 or more prior visits: OR = 6.80, p = 0.00). The odds of a return visit within 2 weeks were not different by clinic type after adjusting for propensity to use services (OR = 1.17, p = 0.28). After adjusting for case mix differences, return visit rates did not differ by clinic type. (Population Health Management 2012;15:xx–xx) Introduction R etail walk-in clinics staffed by nurse practitioners and physician assistants are becoming increasingly popular because they are more convenient and less expensive than scheduled appointments for low-acuity visits in the tra- ditional medical practice. As these clinics have been estab- lished, some studies have reported about their effects on cost, quality, and access. However, relatively few studies have addressed this topic given the substantial growth in this care modality. Walk-in care centers were first developed in the United States in the early 1970s as free-standing emergency care centers in an effort to offer a lower-cost alternative to emergency department visits. 1–3 At least 1 study reported that patients in rural areas tend to use walk-in clinics as a supplement to, rather than a substitute for, having a regular physician. 4 The quality of medical care provided in walk-in clinics appears to be good. 5 Walk-in clinics are superior to emergency department visits when clinically appropriate because emergency department visits are more likely to re- sult in return visits. 6 The advantages of walk-in care centers include greater convenience, 7,8 good technical quality, 9 and lower cost than emergency department and routine office visits. Because of their superior accessibility, primary care walk-in clinics may be able to reduce disparities in access to medical care. 10 However, this last point (ie, that walk-in clinics improve access) has been disputed. 11,12 Nontraditional care visits may increase the cost of medical care if they increase the risk of an early return visit to an emergency department or medical office. When the evidence was examined more than 10 years ago, Jones was able to report no evidence to support this concern. 1 Subsequent studies explored the impact of walk-in primary care clinics on emergency department use or ‘‘reconsultations’’ by pri- mary care physicians and reached similar conclusions. 8,13,14 This issue warrants further investigation. The purpose of the current study is to test the hypothesis that patients seen in standard medical offices are less likely Department of Family Medicine, Mayo Clinic-Rochester, Rochester, Minnesota. POPULATION HEALTH MANAGEMENT Volume 15, Number 00, 2012 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2011.0058 1 POP-2011-0058-ver9-Rohrer_1P Type: research-article POP-2011-0058-ver9-Rohrer_1P.3d 01/11/12 6:46pm Page 1