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Delaware Community Health Access Program (CHAP): Evaluation of Referrals and Health Outcomes

Delaware Community Health Access Program (CHAP): Evaluation of Referrals and Health Outcomes. James M. Gill, MD, MPH Christiana Care Health Services August 21st, 2003. Introduction. CHAP objectives

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Delaware Community Health Access Program (CHAP): Evaluation of Referrals and Health Outcomes

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  1. Delaware Community Health Access Program (CHAP):Evaluation of Referrals and Health Outcomes James M. Gill, MD, MPH Christiana Care Health Services August 21st, 2003

  2. Introduction • CHAP objectives • Provide a medical home for uninsured Delawareans, so as to improve access, quality and outcomes • Increase primary and preventive care • Reduce hospital emergency department (ED) visits and hospital stays • Improve health status and patient satisfaction

  3. Methods: Part 1 • Study Design • Compared changes in health care utilization and other outcomes before CHAP enrollment and six months after enrollment • 795 qualified enrollees • Time Period • June 2001 through January 2003

  4. Demographics • CHAP enrollees tend to be • Young adults (18 - 39 years of age) • Female • New Castle County • Hispanic • Non-citizens

  5. Preventive Care Past 5 year, ages 35+ (N=252) Past 2 years ages 40+ (N=123) Past 2 years ages 18+ (N=123) Past 3 years ages 18+ (N=484

  6. Preventive Care Past year ages 50+ or <50 with diabetes or asthma (N=138) Ever ages 65+ or <with diabetes (N=45) Past 5 years ages 50+ (N=104) Past year ages 50+ (N=104)

  7. Emergency Department and Hospital Visits

  8. Satisfaction with Care Excellent Excellent

  9. Methods: Part 2 • Study Design • Examined referral patterns, including sources of referrals to health homes • Identified percent seen at health homes after enrollment • Investigated percentage already patients prior to CHAP • Time Period • Beginning June 2001 and ending November 2002

  10. Health Home Referrals(N=2525)

  11. Percent of Referrals Leading to Health Home Visits N=2116 N=13 N=262 N=1841

  12. Percent of Enrollees Who Were Patients Prior to Enrollment (N=2116) (N=185) (N=126) (N=742) (N=1063)

  13. Time Between First Pre-CHAP Visit and CHAP Enrollment (N=1057) (N=54) (N=36) (N=256) (N=711)

  14. SummaryReferrals and Enrollment • Over 2500 persons enrolled in CHAP in initial 16 months • Another 400-500 enrolled in Medicaid • Largest providers LaRed and Westside Followed by VIP 2 • Most captured at health homes themselves; only 21 percent at ED’s • 50-60 percent of those referred to health home make visit • 30-40 percent referred to health home were already patients there

  15. SummaryChanges in Health Care Utilization • Substantial increases in some preventive care (Pap’s, mammograms, cholesterol) • Small impact on CRC screening and adult immunizations • Significant reductions in ED visits, but not hospitalizations • Dramatic improvements in satisfaction with care

  16. Caveats • Short time frame: establishing medical home takes longer to accrue benefits • Not able to capture all benefits; may have less unnecessary care and fewer medication errors by shifting care from ED to primary care • Medical home is essential but not sufficient for optimal care • CRC screening may require additional interventions (e.g., education, payment)

  17. Future Directions • New CHAP data collection tool • Impact on efficiency and cost • Continue to monitor Colorectal Cancer Screening, PAPs and Mammograms • Evaluate CHAP as part of overall uninsured in DE • Colorectal Cancer Screening • Women’s Health

  18. Demographics (N=795)

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