Use of HIT to Increase Primary Care Access in Medicaid Patients (Ohio)

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Summary:

The most frequent users of emergency department (ED) services are patients covered by Medicaid who use them for non-urgent or routine health services. This results in increased costs to health systems and society, and reduced quality of care. A common reason for inappropriate ED use by Medicaid patients is a lack of regular access to primary care physicians (PCPs), indicating a critical need for programs that can help direct patients to appropriate and accessible health care.

The goal of this project was to improve access to primary care for Medicaid patients and improve coordination of care across transitions in health care settings.

The specific aims of the project were as follows:

  • Develop, implement, and evaluate an ED-PCP Connector program using a health information technology-based intervention to reduce ED utilization and increase primary care access for Medicaid patients who do not have a regular source of primary care. 
  • Improve Medicaid patients’ satisfaction with care and improve communications between the ED and PCPs through use of an ED-PCP Connector program. 

A randomized controlled trial was used to evaluate the impact of the ED-PCP Connector program. Patients randomized to the intervention group were scheduled to follow up with a primary care physician of the patient’s preference as to location, date, and gender, and given a reminder card with directions to their chosen practice location. A message was then sent through the electronic medical record to the physician providing the patient’s name, medical record number, date and time of the scheduled appointment, and the reason for the ED visit. Patients randomized to the comparison group were asked to schedule their own appointment with a PCP, and given a handout to aid in selection and scheduling.

Twenty eight percent of patients in the intervention group and 13 percent in the comparison group attended at least one primary care visit within 3 months of their ED visit. While intervention patients were 2.5 times more likely to follow up with the primary care doctor, overall 62 percent of patients did not keep their appointments. Study participants indicated that they found the ED-PCP Connector program helpful for finding a PCP, scheduling an appointment, and developing a relationship with a physician. Common barriers to attending appointments included lack of transportation and childcare needs. Patients also frequently cited resolution of symptoms and a lack of a need for followup as causes for not keeping appointments. The researchers concluded that, although removal of system barriers is necessary to increase access to primary care for the Medicaid population, there is also a need to address socioeconomic barriers.

Use of HIT to Increase Primary Care Access in Medicaid Patients - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality Through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 020693
  • Project Period: 
    September 2011 – August 2013
  • AHRQ Funding Amount: 
    $300,000
  • PDF Version: 
    (PDF, 180.75 KB)

Summary: Hospital emergency departments (EDs) are often used for non-urgent or routine health services, which can result in considerably higher health care expenditures than services provided in a primary care setting. For patients covered by Medicaid, ED visits as a proportion of all ambulatory care visits are more than double the proportion for those with private insurance. The Patient Protection and Affordable Care Act is projected to increase the number of patients receiving Medicaid coverage by 16 million. Because the biggest users of ED services are people covered by Medicaid, the project team is using education and programs to direct this population to appropriate health care services in an effort to decrease their ED usage to levels of other users.

The purpose of this research project is to develop, implement, and evaluate an Emergency Department- Primary Care Provider (ED-PCP) Connector program to improve access to primary care for Medicaid patients and improve coordination of care across transitions in health care settings. The ED-PCP Connector program is innovative in its use of health information technology (IT) to facilitate and improve patient access to care by scheduling patient followup in real time and providing PCPs with access to patients’ medical records through a functional electronic health record (EHR) system that can connect the hospital ED to PCP offices.

In a randomized controlled trial of this intervention, study staff will test whether the program makes a difference in quantitative and qualitative assessments, including measures of ED utilization, assessments of patient satisfaction, and evaluations of physicians’ opinions about the program’s ability to improve communication between the ED and PCP settings.

All subjects will be surveyed about satisfaction with the process. In addition, the team will follow all subjects for primary care and ED use during the study period. There will be three phases to this proposed research: 1) development; 2) implementation; and 3) evaluation.

Specific Aims:

  • Develop, implement, and evaluate an ED-PCP Connector program using a health IT-based intervention to reduce ED utilization and increase primary care access for Medicaid patients who do not have a regular source of primary care. (Ongoing)
  • Improve Medicaid patients’ satisfaction with care and improve communications between the ED and PCPs through use of an ED-PCP Connector program. (Ongoing)

2012 Activities: The project received institutional review board approval for taping interviews. The team made efforts to update contact information in the patient medical records and to communicate with participants to obtain permission to contact EDs around Columbus, OH in order to track their utilization. Obtaining ED data from other health systems was a particular challenge because the team does not have the ability to access ED data electronically from them. As a result, this aspect is being done manually with a release of information sent to two health systems involved in the study. Requests for data were sent to the EDs of these systems.

The project completed recruitment of 100 subjects. A preliminary data extract showed an approximate 40 percent show rate. Five people have completed the cycle, and 65 have completed the 3-month followup. As last self-reported in the AHRQ Research Reporting System, project progress and activities are completely on track and spending is on target.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Adults, Medicaid

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

Use of HIT to Increase Primary Care Access in Medicaid Patients - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 020693
  • Project Period: 
    September 2011 - August 2013
  • AHRQ Funding Amount: 
    $300,000
  • PDF Version: 
    (PDF, 158.57 KB)

Summary: Hospital emergency departments (EDs) are often used for non-urgent or routine health services, which can result in considerably higher health care expenditures than services provided in a primary care setting. For patients covered by Medicaid, ED visits as a proportion of all ambulatory care visits are more than double the proportion for those with private insurance. The Patient Protection and Affordable Care Act is projected to increase the number of patients receiving Medicaid coverage by 16 million. Because the biggest users of ED services are people covered by Medicaid, the project team is using education and programs to direct this population to appropriate health care services in an effort to bring their usage of the ED in line with other users.

This research project seeks to develop, implement, and evaluate an Emergency Department-Primary Care Provider (ED-PCP) Connector program to improve access to primary care for Medicaid patients and improve coordination of care across transitions in health care settings. The ED-PCP Connector program is innovative in its use of health information technology (IT) to facilitate and improve patient access to care by scheduling patient followup in real time and providing PCPs with access to patients' medical records through a functional electronic health record (EHR) system that can connect the hospital ED to PCP offices.

In a randomized controlled trial of this intervention, study staff will test whether the program makes a difference in quantitative and qualitative assessments, including measures of ED utilization, assessments of patient satisfaction, and evaluations of physicians' opinions about the program's ability to improve communication between the ED and PCP settings.

All subjects will be surveyed regarding satisfaction with the process. In addition, the team will follow all subjects for primary care and ED use during the study period. There will be three phases to this proposed research: 1) development; 2) implementation; and 3) evaluation.

Specific Aims:

  • Develop, implement, and evaluate an ED-PCP Connector program using a health IT-based intervention to reduce ED utilization and increase primary care access for Medicaid patients who do not have a regular source of primary care. (Ongoing)
  • Improve Medicaid patients' satisfaction with care and improve communications between the ED and PCPs through use of an ED-PCP Connector program. (Ongoing)

2011 Activities: The study began in the last quarter of 2011 and the research team focused on start-up activities. During this period, several key steps were developed, including material development and documentation for institutional review board; review of the EHR electronic scheduling system to develop a referral mechanism for patients; development of a studyspecific database to track activities and data points of the study; processes to permit study-data collection at the baseline, 6-week, 6-, and 12-month periods; and the adaptation of both the client satisfaction questionnaire and multi-dimensional Health Locus of Control Scales Form A survey.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are completely on track and the project budget is roughly on track.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Adults, Medicaid

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

Use of HIT to Increase Primary Care Access in Medicaid Patients - Final Report

Citation:
Wexler R. Use of HIT to Increase Primary Care Access in Medicaid Patients - Final Report. (Prepared by the Ohio State University under Grant No. R21 HS020693). Rockville, MD: Agency for Healthcare Research and Quality, 2014. (PDF, 279.1 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison)
Principal Investigator: 
Document Type: 
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