Meghana Anugu1, Amy Braksmajer2, Jiayu Huang3, Jie Yang4, Kristi L Ladowski2, Susmita Pati5,6. 1. School of Medicine, Stony Brook University, Stony Brook, New York; and. 2. Division of Primary Care Pediatrics. 3. Department of Applied Mathematics and Statistics, and. 4. Department of Family, Population and Preventive Medicine. 5. Division of Primary Care Pediatrics, susmita.pati@stonybrookmedicine.edu. 6. Stony Brook University Medical Center, Stony Brook, New York.
Abstract
BACKGROUND AND OBJECTIVES: Community health workers (CHWs) have great potential to extend medical home services and reduce emergent health care use, but evidence in pediatrics is scarce. We evaluated the impact of an existing enriched medical home intervention (EMHI) that directly integrates CHWs into emergency department (ED) visits and hospitalizations for pediatric ambulatory care-sensitive conditions (ACSCs). METHODS: The EMHI group in this prospective cohort study received home visits from trained CHWs to support adherence to recommended care; the comparison group received usual care (UC). Sociodemographic characteristics were compiled from the EMHI database, and ED and hospitalization information was extracted for study participants from a statewide database. The Wilcoxon signed rank test was used to compare ED data and the Wald test was used to compare hospitalization use for ACSCs between the intervention and UC groups after adjusting for different characteristics between groups by using propensity score matching method. RESULTS: The study sample included 922 children (225 intervention, 697 UC). After propensity score matching, the analytic sample included 450 children (225 intervention, 225 UC). After propensity score matching, the intervention group was significantly less likely than the UC group to visit the ED for an ACSC (18.2% vs 35.1%; P = .004). We found no differences in ACSC hospitalizations between the 2 groups. CONCLUSIONS: Our findings suggest that EMHIs using trained CHWs may be a cost-effective model to reduce preventable ED utilization, especially among vulnerable children.
BACKGROUND AND OBJECTIVES: Community health workers (CHWs) have great potential to extend medical home services and reduce emergent health care use, but evidence in pediatrics is scarce. We evaluated the impact of an existing enriched medical home intervention (EMHI) that directly integrates CHWs into emergency department (ED) visits and hospitalizations for pediatric ambulatory care-sensitive conditions (ACSCs). METHODS: The EMHI group in this prospective cohort study received home visits from trained CHWs to support adherence to recommended care; the comparison group received usual care (UC). Sociodemographic characteristics were compiled from the EMHI database, and ED and hospitalization information was extracted for study participants from a statewide database. The Wilcoxon signed rank test was used to compare ED data and the Wald test was used to compare hospitalization use for ACSCs between the intervention and UC groups after adjusting for different characteristics between groups by using propensity score matching method. RESULTS: The study sample included 922 children (225 intervention, 697 UC). After propensity score matching, the analytic sample included 450 children (225 intervention, 225 UC). After propensity score matching, the intervention group was significantly less likely than the UC group to visit the ED for an ACSC (18.2% vs 35.1%; P = .004). We found no differences in ACSC hospitalizations between the 2 groups. CONCLUSIONS: Our findings suggest that EMHIs using trained CHWs may be a cost-effective model to reduce preventable ED utilization, especially among vulnerable children.
Authors: Neera K Goyal; Courtney M Brown; Alonzo T Folger; Eric S Hall; Judith B Van Ginkel; Robert T Ammerman Journal: Matern Child Health J Date: 2020-01
Authors: Kristin N Ray; Kristin A Yahner; Jamil Bey; Katherine C Martin; Arrianna M Planey; Alison J Culyba; Elizabeth Miller Journal: Health Aff (Millwood) Date: 2021-01 Impact factor: 6.301