Expanding the Safety Net of Specialty Care for the Uninsured: A Case Study

Robert Wood Johnson Foundation Clinical Scholars Program, Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
Health Services Research (Impact Factor: 2.78). 10/2011; 47(1 Pt 2):344-62. DOI: 10.1111/j.1475-6773.2011.01330.x
Source: PubMed


To describe core principles and processes in the implementation of a navigated care program to improve specialty care access for the uninsured.
Academic researchers, safety-net providers, and specialty physicians, partnered with hospitals and advocates for the underserved to establish Project Access-New Haven (PA-NH). PA-NH expands access to specialty care for the uninsured and coordinates care through patient navigation.
Case study to describe elements of implementation that may be relevant for other communities seeking to improve access for vulnerable populations.
Implementation relied on the application of core principles from community-based participatory research (CBPR). Effective partnerships were achieved by involving all stakeholders and by addressing barriers in each phase of development, including (1) assessment of the problem; (2) development of goals; (3) engagement of key stakeholders; (4) establishment of the research agenda; and (5) dissemination of research findings.
Including safety-net providers, specialty physicians, hospitals, and community stakeholders in all steps of development allowed us to respond to potential barriers and implement a navigated care model for the uninsured. This process, whereby we integrated principles from CBPR, may be relevant for future capacity-building efforts to accommodate the specialty care needs of other vulnerable populations.

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  • No preview · Article · Feb 2012 · Health Services Research
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    ABSTRACT: Uninsured individuals face great challenges in accessing both primary and specialty care. The Access Partnership (TAP) is a novel collaboration between primary and specialty care providers at an urban academic medical center to provide care coordination and facilitate access to specialty services for uninsured patients. We reviewed administrative data and performed phone surveys of the 213 patients who entered the program over a one-year period. Specialty care visit attendance was analyzed from administrative data for these patients. We then surveyed patients by phone (60% response rate). Patient-reported access to care and satisfaction with care were significantly higher after TAP (33% vs. 87%, p<0.001 and 41% vs. 91%, p<0.001, respectively). 89% of referrals were completed within 90 days among TAP patients, a rate similar to studies involving insured patients. TAP enrollment was associated with significantly decreased patient-reported barriers to specialty care as well as improved access to and satisfaction with care.
    No preview · Article · Aug 2012 · Journal of Health Care for the Poor and Underserved
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    ABSTRACT: The annual number of emergency department (ED) visits in the United States increased 23% between 1997 and 2007. The uninsured and those with chronic medical conditions are high users of emergency care. We sought to determine whether access to comprehensive outpatient primary and specialty care and care coordination provided by The Access Partnership (TAP) reduced ED utilization among uninsured patients relative to patients who chose not to enroll. Multiple time series analysis was performed to examine rates of ED utilization and inpatient admission among TAP patients and a comparison group of eligible patients who did not join (non-TAP patients). Monthly ED utilization and inpatient admission rates for both groups were examined prior to and subsequent to referral to TAP, within a study period 2007-2011. During the study period, 623 patients were eligible to enroll, and 374 joined the program. Rates of ED visits per month increased in both groups. Compared with non-TAP patients, TAP patients had 2.0 fewer ED visits not leading to admission per 100 patient-months post-TAP (P = .03, 95% confidence interval = 0.2-3.9). TAP status was a moderate predictor of ED visits not leading to admission, after controlling for age, gender, and zip code (P = .04, 95% confidence interval = 0.1-3.9). Although overall ED utilization did not change significantly between program participants and nonparticipants, TAP patients had a lower rate of ED visits not resulting in inpatient admission relative to the comparison group.
    No preview · Article · Apr 2013 · Journal of primary care & community health
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