Delaware Community Health Access Program (CHAP): Evaluation of Referrals and Health Outcomes James M. Gill, MD, MPH Christiana Care Health Services August 21st, 2003

Introduction l CHAP objectives –Provide a medical home for uninsured Delawareans, so as to improve access, quality and outcomes –Increase primary and preventive care –Reduce hospital emergency department (ED) visits and hospital stays –Improve health status and patient satisfaction

Methods: Part 1 l Study Design –Compared changes in health care utilization and other outcomes before CHAP enrollment and six months after enrollment –795 qualified enrollees l Time Period –June 2001 through January 2003

Demographics l CHAP enrollees tend to be –Young adults ( years of age) –Female –New Castle County –Hispanic –Non-citizens

Preventive Care Past 5 year, ages 35+ (N=252) Past 2 years ages 40+ (N=123) Past 2 years ages 18+ (N=123) Past 3 years ages 18+ (N=484

Preventive Care Past year ages 50+ or <50 with diabetes or asthma (N=138) Ever ages 65+ or <with diabetes (N=45) Past 5 years ages 50+ (N=104) Past year ages 50+ (N=104)

Emergency Department and Hospital Visits

Satisfaction with Care Excellent

Methods: Part 2 l Study Design –Examined referral patterns, including sources of referrals to health homes –Identified percent seen at health homes after enrollment –Investigated percentage already patients prior to CHAP l Time Period –Beginning June 2001 and ending November 2002

Health Home Referrals (N=2525)

Percent of Referrals Leading to Health Home Visits N=2116 N=262 N=1841 N=13

Percent of Enrollees Who Were Patients Prior to Enrollment (N=185)(N=126)(N=742)(N=1063)(N=2116)

Time Between First Pre-CHAP Visit and CHAP Enrollment (N=1057)(N=54)(N=36)(N=256)(N=711)

Summary Referrals and Enrollment l Over 2500 persons enrolled in CHAP in initial 16 months –Another enrolled in Medicaid l Largest providers LaRed and Westside Followed by VIP 2 l Most captured at health homes themselves; only 21 percent at ED’s l percent of those referred to health home make visit l percent referred to health home were already patients there

Summary Changes in Health Care Utilization l Substantial increases in some preventive care (Pap’s, mammograms, cholesterol) l Small impact on CRC screening and adult immunizations l Significant reductions in ED visits, but not hospitalizations l Dramatic improvements in satisfaction with care

Caveats l Short time frame: establishing medical home takes longer to accrue benefits l Not able to capture all benefits; may have less unnecessary care and fewer medication errors by shifting care from ED to primary care l Medical home is essential but not sufficient for optimal care l CRC screening may require additional interventions (e.g., education, payment)

Future Directions l New CHAP data collection tool –Impact on efficiency and cost l Continue to monitor Colorectal Cancer Screening, PAPs and Mammograms l Evaluate CHAP as part of overall uninsured in DE –Colorectal Cancer Screening –Women’s Health

Demographics (N=795)