Lauren Kelley1, Roberta Capp2, Juan F Carmona1, Gail D'Onofrio2, Hao Mei3, Darcey Cobbs-Lomax1, Peter Ellis4. 1. Project Access-New Haven, New Haven, Connecticut. 2. Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. 3. Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut. 4. Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
Abstract
BACKGROUND: Some Medicaid enrollees frequently utilize the emergency department (ED) due to barriers accessing health care services in other settings. OBJECTIVES: To determine whether an ED-initiated Patient Navigation program (ED-PN) designed to improve health care access for Medicaid-insured frequent ED users could decrease ED visits, hospitalizations, and costs. METHODS: We conducted a prospective, randomized controlled trial comparing ED-PN with usual care (UC) among 100 Medicaid-enrolled frequent ED users (defined as 4-18 ED visits in the prior year), assessing ED utilization during the 12 months pre- and post-enrollment. Secondary outcomes included hospitalizations, outpatient utilization, hospital costs, and Medicaid costs. We also compared characteristics between ED-PN patients with and without reduced ED utilization. RESULTS: Of 214 eligible patients approached, 100 (47%) consented to participate. Forty-nine were randomized to ED-PN and 51 to UC. Sociodemographic characteristics and prior utilization were similar between groups. ED-PN participants had a significant reduction in ED visits and hospitalizations during the 12-month evaluation period compared with UC, averaging 1.4 fewer ED visits per patient (p = 0.01) and 1.0 fewer hospitalizations per patient (p = 0.001). Both groups increased outpatient utilization. ED-PN patients showed a trend toward reduced per-patient hospital costs (-$10,201, p = 0.10); Medicaid costs were unchanged (-$5,765, p = 0.26). Patients who demonstrated a reduction in ED usage were older (mean age 42 vs. 33 years, p = 0.03) and had lower health literacy (78% low health literacy vs. 40%, p = 0.02). CONCLUSION: An ED-PN program targeting Medicaid-insured high ED utilizers demonstrated significant reductions in ED visits and hospitalizations in the 12 months after enrollment.
RCT Entities:
BACKGROUND: Some Medicaid enrollees frequently utilize the emergency department (ED) due to barriers accessing health care services in other settings. OBJECTIVES: To determine whether an ED-initiated Patient Navigation program (ED-PN) designed to improve health care access for Medicaid-insured frequent ED users could decrease ED visits, hospitalizations, and costs. METHODS: We conducted a prospective, randomized controlled trial comparing ED-PN with usual care (UC) among 100 Medicaid-enrolled frequent ED users (defined as 4-18 ED visits in the prior year), assessing ED utilization during the 12 months pre- and post-enrollment. Secondary outcomes included hospitalizations, outpatient utilization, hospital costs, and Medicaid costs. We also compared characteristics between ED-PNpatients with and without reduced ED utilization. RESULTS: Of 214 eligible patients approached, 100 (47%) consented to participate. Forty-nine were randomized to ED-PN and 51 to UC. Sociodemographic characteristics and prior utilization were similar between groups. ED-PNparticipants had a significant reduction in ED visits and hospitalizations during the 12-month evaluation period compared with UC, averaging 1.4 fewer ED visits per patient (p = 0.01) and 1.0 fewer hospitalizations per patient (p = 0.001). Both groups increased outpatient utilization. ED-PNpatients showed a trend toward reduced per-patient hospital costs (-$10,201, p = 0.10); Medicaid costs were unchanged (-$5,765, p = 0.26). Patients who demonstrated a reduction in ED usage were older (mean age 42 vs. 33 years, p = 0.03) and had lower health literacy (78% low health literacy vs. 40%, p = 0.02). CONCLUSION: An ED-PN program targeting Medicaid-insured high ED utilizers demonstrated significant reductions in ED visits and hospitalizations in the 12 months after enrollment.
Authors: Elizabeth A Samuels; Lauren Kelley; Timothy Pham; Jeremiah Cross; Juan Carmona; Peter Ellis; Darcey Cobbs-Lomax; Gail D'Onofrio; Roberta Capp Journal: West J Emerg Med Date: 2021-02-22