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Community-Based Case Management for Uninsured Patients With Chronic Diseases: Effects on Acute Care Utilization and Costs

Glendenning-Napoli, Alison BSN, RN-BC; Dowling, Beverly CPA, CHFP; Pulvino, John PA-C; Baillargeon, Gwen MS; Raimer, Ben G. MD

doi: 10.1097/NCM.0b013e3182687f2b

Purpose of the Study: To examine the effects of a community-based case management program on acute health care utilization and associated costs in uninsured patients with 1 or more chronic diseases.

Primary Practice Setting: Large regional academic medical center that provides health care services for the vast majority of indigent patients in the area.

Methodology and Sample: This was a retrospective study of 83 patients who enrolled in a case management program between April 2007 and August 2008 on the basis of 1 or more emergency department visits or acute hospitalizations. Paired t tests were used to compare utilization and costs before and after enrollment.

Results: Overall, acute outpatient encounters decreased by 62% and inpatient admissions by 53%, whereas primary care visits increased by 162%. Participation in the case management program was also associated with a 41% reduction in overall aggregate costs, from $16,208 preintervention to $9,541 postintervention (p = .004).

Implications for Case management Practice: The results of this study suggest that intensive case management can reduce acute care utilization and costs and increase primary care follow-up among uninsured patients with certain chronic diseases.

Alison Glendenning-Napoli, BSN, RN-BC, is Director of outpatient care management and oversees the Community Health Program at the University of Texas Medical Branch. She has more than 16 years of experience in program development, case management, and nursing leadership. She is board certified in case management and is currently pursuing chronic care professional certification.

Beverly Dowling, CPA, CHFP, is Assistant Vice President of the University of Texas Medical Branch Community Health Network. She has 20 years of experience in health care with a focus on implementing new health care delivery models for uninsured and underinsured populations.

John Pulvino, PA-C, is Senior Director of quality and outcomes for the Correctional Managed Care Program at the University of Texas Medical Branch. He has more than 20 years of experience in developing, implementing, and refining quality improvement and case management processes in the health care field.

Gwen Baillargeon, MS, is a biostatistician for the Correctional Managed Care Program at the University of Texas Medical Branch. Gwen has more than 13 years of experience as a biostatistician and SAS programmer in the pharmaceutical industry and the academic setting and has coauthored a number of publications in peer-reviewed medical journals.

Ben G. Raimer, MD, is Professor in the Departments of Pediatrics, Family Medicine, and Preventive Medicine and Community Health at the University of Texas Medical Branch and Senior Vice President of the Office of Health Policy and Legislative Affairs. He has extensive experience in developing programs to improve the delivery and quality of health care for rural and underserved populations in Texas.

Address correspondence to Alison Glendenning-Napoli, BSN, RN-BC, Community Health Program, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555 (

This study was presented in part at the 139th Annual Meeting of the American Public Health Association, Washington, DC, November 1, 2011.

The authors report no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.