The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured

Texas Prevention Institute, School of Public Health, University of North Texas Health Science Center, Ft. Worth, TX 76107, USA.
Journal of Public Health (Impact Factor: 2.04). 05/2012; 34(4). DOI: 10.1093/pubmed/fds027
Source: PubMed


BACKGROUND: Approximately 19% of non-elderly adults are without health insurance. The uninsured frequently lack a source of primary care and are more likely to use the emergency department (ED) for routine care. Improving access to primary care for the uninsured is one strategy to reduce ED overutilization and related costs. METHODS: A comparison group quasi-experimental design was used to evaluate a broad-based community partnership that provided access to care for the uninsured-Project Access Dallas (PAD)-on ED utilization and related costs. Eligible uninsured patients seen in the ED were enrolled in PAD (n = 265) with similar patients not enrolled in PAD (n = 309) serving as controls. Study patients were aged 18-65 years, <200% of the federal poverty level and uninsured. Outcome measures include the number of ED visits, hospital days and direct and indirect costs. RESULTS: PAD program enrollees had significantly fewer ED visits (0.93 vs. 1.44; P < 0.01) and fewer inpatient hospital days (0.37 vs. 1.07; P < 0.05) than controls. Direct hospital costs were ∼60% less ($1188 vs. $446; P < 0.01) and indirect costs were 50% less ($313 vs. $692; P < 0.01). CONCLUSIONS: A broad-based community partnership program can significantly reduce ED utilization and related costs among the uninsured.

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    • "Research shows that the choice of type of unscheduled out-of-hours health care (hospital-based versus primary care setting) is socially determined [7-11]. However, the strength and even the direction of the relation seems to be highly dependent on other patient characteristics [11-13]. In this context, the availability of services and distance between the patient’s home and both types of services is suggested as a confounding factor [13]. "
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