Health Promotion Interventions - Reducing Emergency Room Use and Cost Among the Uninsured
Emergency departments (ED) in the U.S. are a vital source of care for those without insurance who generally lack a source of primary care, since they are required by law to treat patients regardless of their ability to pay.39,40 Care delivered through the ED is frequently for non-urgent problems, is substantially more costly than comparable care delivered in the primary care setting, and can produce significant financial charges for the uninsured and hospitals.41-43 Our team worked with a group of collaborators to improve access to continuity and preventive care for the uninsured, reduce ED utilization and costs, provide better chronic disease management, reduce health disparities, and increase quality of life.44-46 Project Access Dallas (PAD) partners included faith-based organizations, government agencies and social service organizations, hospitals and the local medical society, several universities and a medical school. It was a local community system that provided access to existing nonprofit community health clinics, volunteer primary and specialty care physicians, and local hospitals and pharmacies.47
The core of the PAD program was a Community Care Coordination system (Care Coordination) using community health workers (CHWs) to provide culturally competent case management when patients encounter social and economic barriers while trying to access and navigate health-related services. The CHWs were recruited from the local community and received basic training in social services delivery, health care system logistics, preventive care, and understanding physical and mental health. Their role was to coordinate referrals and access to care for patients, and provide support services and referral for social determinants of health needs, translation services for non-English speakers, health education, home visits, appointment compliance reminders, and encouragement to follow health prescriptions.
Two key studies examined the effectiveness of the PAD program from the perspective of patients using the system and the effect on reducing costs in the local hospital system. In the first, patients were surveyed to determine whether and how the CHWs effected their health and care delivery. Findings indicated that the PAD Community Care Coordination helped patients understand more about their health and how to navigate a complex health care system, helped patients learn how to independently manage their chronic health issues through self-care, guided patients efficiently to appropriate care services, and provided emotional support.48 The second study indicated that the PAD system significantly reduced emergency department utilization and related hospital costs among patients enrolled in the PAD system.47,48 PAD patients had significantly fewer ED visits and hospital days one year following their enrollment when compared with patients not enrolled in PAD, and their direct and indirect hospital costs were 60% less and 50% less, respectively.47