The Reduction of Emergency Room Visits for Non- Emergent Health Concerns in Bakersfield, California Mariah Walton, MPH Public Health Advisor Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2016 PHAP Spring Seminar April 7, 2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

BAKERSFIELD, KERN COUNTY Data Source: US Census Bureau, American Community Survey Source geography: TractAmerican Community Survey

 Increased emergency room (ER) visits since 2000  ER usage rate: (2000) to (2012)  Hospitals operating over capacity  Rise in health care cost  $3 trillion spent on health care  $18 billion wasted in health expenditures  Preventable visits  55% of ER visits are non-urgent  Health centers save the healthcare system over $24 billion through the provision of effective and efficient care 1.Weiss, Audrey J., Lauren M. Wier, Carol Stocks, and Janice Blanchard. "Overview of Emergency Department Visits in the United States, 2011." HCUP Statistical Brief #174. June Web. 18 Mar Ku L, et al. Using primary care to bend the cost curve: Estimating the impact of a health center expansion of health care costs. Policy Research Brief No Geiger Gibson/RCHN Community Health Foundation Collaborative at the George Washington University. Why Are Emergency Room (ER) Reduction Programs Important?

 California ER Discharges: n= 11,562,550 Gender: Females = 55%; Males = 45% Population: White (39%), Hispanic (38%), Black (11.2%), Asian (5%), Other (6%)  Kern County ER Discharges: n= 311,348 Gender: Females = 57%; Males = 44% Population: White (40%), Hispanic (47%), Black (9%), Other (2.5%)  Bakersfield ER Discharges: n= 267,177 Gender: Females = 55%; Males = 45% Population: White (37%), Hispanic (48%), Black (11%), Other (3.4%) * Office of Statewide Health Planning and Development. (2014) California emergency department data Why Are ER Reduction Programs Important?

What does the trend look like? OSHPD. (2014)

Emergency Medical Services and Public Health Nursing Divisions

 2014 Operations  EMS Database Prioritized based on acuity level and assigned to a Public Health Nurse  2015 Operations  Hospital Referrals All eligible referrals accepted and assigned to a Public Health Nurse Program Overview Inclusion Criteria:  Resident of Bakersfield, CA  18 years or older  Accessed emergency resources 10 or more times within a 6 month period Maximum caseload: 2 patients/ Nurse

 Step 1: Planning  Conducted literature reviews of successful ER reduction programs  Developed materials such as logic model, Gantt chart, protocols, and tracking tools  Trained internal and external nursing staff on how to refer and track improvements  Developed secured database for monitoring patients’ case management  Developed partner engagement workgroup Methods

 Step 2: Implementation  Collected baseline ER usage data from two hospitals  Public Health Nurses conducted home visits  Created brochures for hospitals to educate patients Methods

 Step 3: Evaluation  Tracked # of received referrals  Tracked patient ER visits during and post-intervention  Tracked services provided Methods

Program Results  There were 32 patients referred and 18 eligible for case management.  241 total ER visits for the 18 enrolled patients  83% (n=15) were insured by Medi-Cal, Medicare, or Private Insurance  Complex health concerns  Mental Health  Substance abuse and/or alcoholism  Hypertension  Diabetes  Gastritis Patient Demographics Gender Male633% Female1266% Race White950% Hispanic738% Black211% Average age: 49

Program Results  Each patient linked to one or more of the following services:  Primary Care Provider  Health insurance  Transportation  Life skills programs  Mental health  Housing  Disease management

Program Results

Successes  Improved quality of life for 7 residents  Reduced ER visits by 68% (n=241 to n=77)  Decreased average cost per patient/visit by 89% (n=$5,010 to n=$567)  Administrative successes

Implications  Competing priorities  Inadequate staffing (internal & external)  Lack of partner commitment  Insufficient data sharing methods or fragmented data  Sustainable funding methods

Next Steps  Coordinate with the local health insurance agency to identify frequent users  Partner with mental health to assist with home visit assessments  Develop program for residents between years old  Invest in a Health Information Exchange (HIE) system and develop policies

For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA Telephone: CDC-INFO ( )/TTY: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Mariah Walton, MPH Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support