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