Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care

Medical Care - Tập 55 Số 2 - Trang 140-147 - 2017
Sanjay Basu1,2,3, Helen E. Jack4,5, Sophia D. Arabadjis4, Russell S. Phillips4,6
1Center on Poverty and Inequality, Stanford University, Stanford, CA
2Centers for Health Policy, Primary Care and Outcomes Research
3Prevention Research Center
4Center for Primary Care, Harvard Medical School, Boston, MA
5Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
6Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA.

Tóm tắt

Background: Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption. Objectives: To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer’s perspective. Research Design: Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program’s expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources. Results: CHWs assigned to patients with uncontrolled hypertension and congestive heart failure, as compared with other common conditions, achieve cost-neutrality with the lowest number of averted visits to the ED. To achieve cost-neutrality, 4–5 visits to the ED would need to be averted per year by a CHW assigned a panel of 70 patients with uncontrolled hypertension or congestive heart failure—approximately 3%–4% of typical ED visits among such patients, respectively. Most other chronic conditions would require between 7% and 12% of ED visits to be averted to achieve cost-savings. Conclusion: Offsetting costs of a CHW program is theoretically feasible for many common conditions. Yet the benchmark for reducing ED visits and associated hospitalizations varies substantially by a patient’s primary diagnosis.

Từ khóa


Tài liệu tham khảo

Vogeli, 2007, Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs, J Gen Intern Med, 22, 391, 10.1007/s11606-007-0322-1

Wang, 2012, Engaging individuals recently released from prison into primary care: a randomized trial, Am J Public Health, 102, e22, 10.2105/AJPH.2012.300894

Kangovi, 2014, Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial, JAMA Intern Med, 174, 535, 10.1001/jamainternmed.2013.14327

Bryant-Stephens, 2008, Outcomes of a home-based environmental remediation for urban children with asthma, J Natl Med Assoc, 100, 306

Shah, 2014, Community health workers and the Patient Protection and Affordable Care Act: an opportunity for a research, advocacy, and policy agenda, J Health Care Poor Underserved, 25, 17, 10.1353/hpu.2014.0019

Behforouz, 2014, Bridging the gap: a community health program saved lives, then closed its doors: a program connecting community health workers with patients in Boston shows benefits but is shuttered after funds dry up, Health Aff, 33, 2064, 10.1377/hlthaff.2013.0952

Kangovi, 2015, From rhetoric to reality — community health workers in post-reform US health care, N Engl J Med, 372, 2277, 10.1056/NEJMp1502569

Fisher, 2009, A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach, Arch Pediatr Adolesc Med, 163, 225, 10.1001/archpediatrics.2008.577

Gary, 2009, The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial, Arch Intern Med, 169, 1788, 10.1001/archinternmed.2009.338

Fox, 2007, Improving asthma-related health outcomes among low-income, multiethnic, school-aged children: results of a demonstration project that combined continuous quality improvement and community health worker strategies, Pediatrics, 120, e902, 10.1542/peds.2006-1805

Margellos-Anast, 2012, Improving asthma management among African-American children via a community health worker model: findings from a Chicago-Based Pilot Intervention, J Asthma, 49, 380, 10.3109/02770903.2012.660295

Postma, 2011, The feasibility and acceptability of a home-visitation, asthma education program in a rural, Latino/a population, J Asthma, 48, 139, 10.3109/02770903.2010.529221

Turyk, 2013, A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity, J Asthma, 50, 729, 10.3109/02770903.2013.796971

Bryant-Stephens, 2009, Impact of a household environmental intervention delivered by lay health workers on asthma symptom control in urban, disadvantaged children with asthma, Am J Public Health, 99, S657, 10.2105/AJPH.2009.165423

Adair, 2012, Care guides: employing nonclinical laypersons to help primary care teams manage chronic disease, J Ambul Care Manag, 35, 27, 10.1097/JAC.0b013e31823b0fbe

Michelen, 2006, Reducing frequent flyer emergency department visits, J Health Care Poor Underserved, 17, 59, 10.1353/hpu.2006.0010

Johnson, 2012, Community health workers and Medicaid managed care in New Mexico, J Community Health, 37, 563, 10.1007/s10900-011-9484-1

Krieger, 2015, Community health worker home visits for adults with uncontrolled asthma: the HomeBASE trial randomized clinical trial, JAMA Intern Med, 175, 109, 10.1001/jamainternmed.2014.6353

Babamoto, 2009, Improving diabetes care and health measures among Hispanics using community health workers: results from a randomized controlled trial, Health Educ Behav, 36, 113, 10.1177/1090198108325911

Krieger, 2005, The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers, Am J Public Health, 95, 652, 10.2105/AJPH.2004.042994

Nelson, 2011, A randomized controlled trial of parental asthma coaching to improve outcomes among urban minority children, Arch Pediatr Adolesc Med, 165, 520, 10.1001/archpediatrics.2011.57

Enard, 2013, Reducing preventable emergency department utilization and costs by using community health workers as patient navigators, J Healthc Manag, 58, 412

Johnson, 2012, Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions, Med Care, 50, 1020, 10.1097/MLR.0b013e318270bad4

Basu, 2015, Implications of workforce and financing changes for primary care practice utilization, revenue, and cost: a generalizable mathematical model for practice management, Med Care, 53, 125, 10.1097/MLR.0000000000000278

Basu, 2015, Medicare chronic care management payments and financial returns to primary care practices: a modeling study, Ann Intern Med, 163, 580, 10.7326/M14-2677

Viswanathan, 2010, Outcomes and costs of community health worker interventions: a systematic review, Med Care, 48, 792, 10.1097/MLR.0b013e3181e35b51

Wennerstrom, 2015, Integrating community health workers into primary care to support behavioral health service delivery: a pilot study, J Ambul Care Manag, 38, 263, 10.1097/JAC.0000000000000087

Kenya, 2011, Can community health workers improve adherence to highly active antiretroviral therapy in the USA? A review of the literature, HIV Med, 12, 525, 10.1111/j.1468-1293.2011.00921.x

Basu, 2013, Complexity in mathematical models of public health policies: a guide for consumers of models, PLoS Med, 10, e1001540, 10.1371/journal.pmed.1001540

Hofert, 2011, Nested Archimedean copulas meet R: the nacopula package, J Stat Softw, 39, 1, 10.18637/jss.v039.i09

Weinstein, 1996, Recommendations of the panel on cost-effectiveness in health and medicine, JAMA, 276, 1253, 10.1001/jama.1996.03540150055031

Primomo, 2006, Evaluation of a community-based outreach worker program for children with asthma, Public Health Nurs, 23, 234, 10.1111/j.1525-1446.2006.230306.x

Thông tin
Thông tin xuất bản

Medical Care

Tập 55 Số 2

140-147

Thông tin tác giả