The effects of a community-based partnership, Project
Access Dallas (PAD), on emergency department
utilization and costs among the uninsured
M. DeHaven1, H. Kitzman-Ulrich1, N. Gimpel2, D. Culica3, L. O’Neil1, A. Marcee2,
B. Foster2, M. Biggs4, J. Walton5
1Texas Prevention Institute, School of Public Health, University of North Texas Health Science Center, Ft. Worth, TX 76107, USA
2Department of Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
3Texas/Oklahoma AIDS Education & Training Center, Parkland Health and Hospital System, Dallas, TX 75235, USA
4Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
5Baylor Health Care System, Dallas, TX 75246, USA
Address correspondence to Mark DeHaven, E-mail: email@example.com
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 ¼ 265) with similar patients not enrolled in PAD (n ¼ 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.
Keywords health services, primary care, public health
National data indicate that nearly 19% of non-elderly indivi-
duals are without health insurance or nearly 49 million
Americans.1Young adults demonstrate higher rates of being
uninsured with 30% of 19–25 year olds, 28.3% of 26–34
year olds and 22.0% of 35–44 year olds as compared with
14.4% of 55–64 year olds.1These rates increase for indivi-
duals with lower incomes to 34.4% for 19–25 year olds,
36.4% for 26–34 year olds and 31.5% for 35–44 year
olds.1In these age brackets, males have higher rates of being
uninsured as compared with their female counterparts.1
Many of the uninsured are in working families with ?60%
having at least one individual with full-time employment.2
Being uninsured is more common among individuals with
lower incomes and education levels, and among ethnic mi-
norities.1Minority and low-income Americans without in-
surance generally lack a regular source of medical care, and
suffer from medical conditions that are either preventable or
M. DeHaven, Professor
H. Kitzman-Ulrich, Assistant Professor
N. Gimpel, Assistant Professor
D. Culica, Director
L. O’Neil, Associate Professor
A. Marcee, Senior Clinical Analyst
B. Foster, Statistician
M. Biggs, Associate Professor
J. Walton, Vice President of Health Equity and Chief Equity Officer
# The Author 2012, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved
Journal of Public Health | Vol. 34, No. 4, pp. 577–583 | doi:10.1093/pubmed/fds027 | Advance Access Publication 31 May 2012
by guest on November 22, 2015
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