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Evaluation of Care Management for the Uninsured

Shah, Reema MPH*; Chen, Charlene MHS*; O'Rourke, Sheryl MS; Lee, Martin PhD, CStat, CSci; Mohanty, Sarita A. MD, MPH*‡; Abraham, Jennifer MD, MEd

doi: 10.1097/MLR.0b013e3182028e81
Original Article

Background: In 2008, Kern Medical Center established a Care Management Program (CMP) for low-income adults identified as frequent users of hospital services. Frequent users are defined as having 4 or more emergency department (ED) visits or admissions, 3 or more admissions, or 2 or more admissions and 1 ED visit within 1 year. The CMP helps patients access primary care and medical and social resources.

Objective: To determine whether the CMP reduces ED visits and hospitalizations among frequent users.

Method: Between August 2007 and January 2010, a retrospective analysis was conducted using Kern Medical Center encounter data. ED visits and inpatient visits were compared pre- and postenrollment for care managed patients (n = 98). The analysis included a comparison group (n = 160) of frequent users matched on the basis of race and age. Multivariate analyses were performed to evaluate the difference in utilization between groups, and to adjust for potential group differences.

Results: There was a reduction in the median number of ED visits per year from 6.0 ± 5.0 (median ± interquartile range) pre-enrollment to 3.0 ± 4.2 postenrollment (P < 0.0001). The difference in inpatient admissions pre- and postenrollment was 0.0 ± 1.0 (P < 0.0001). After adjusting for multiple factors, multivariate analysis demonstrated that care managed patients had a 32% lower risk of visiting the ED than the comparison group (P < 0.0001). There was no difference in inpatient admissions between groups.

Conclusions: CMP that helps patients navigate the health care system and access social and medical resources show significant promise in reducing ED utilization.

From the *COPE Health Solutions, Los Angeles, CA; †Division of Biostatistics, UCLA School of Public Health, Los Angeles, CA; ‡Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; and ¶David Geffen School of Medicine at UCLA, Department of Medicine at Kern Medical Center, Bakersfield, CA.

Reprints: Sarita A. Mohanty, MD, MPH, COPE Health Solutions, 2400 S. Flower Street, Lowman Building, 3rd Floor, Los Angeles, CA 90007. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.