Delaware Community HealthAccess Program (CHAP):Evaluation of Referrals andHealth Outcomes
James M. Gill, MD, MPH
Christiana Care Health Services
August 21st, 2003
IntroductionIntroduction
lCHAP objectives
–Provide a medical home for uninsuredDelawareans, so as to improve access, qualityand outcomes
–Increase primary and preventive care
–Reduce hospital emergency department (ED)visits and hospital stays
–Improve health status and patient satisfaction
Methods: Part 1Methods: Part 1
lStudy Design
–Compared changes in health care utilization andother outcomes before CHAP enrollment andsix months after enrollment
–795 qualified enrollees
lTime Period
–June 2001 through January 2003
DemographicsDemographics
lCHAP enrollees tend to be
–Young adults (18 - 39 years of age)
–Female
–New Castle County
–Hispanic
–Non-citizens
Preventive CarePreventive 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 CarePreventive Care
Past year
ages 50+ or <50with diabetes orasthma (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 VisitsEmergency Department and Hospital Visits
Satisfaction with CareSatisfaction with Care
Excellent
Excellent
Methods: Part 2Methods: Part 2
lStudy Design
–Examined referral patterns, including sources ofreferrals to health homes
–Identified percent seen at health homes afterenrollment
–Investigated percentage already patients prior toCHAP
lTime Period
–Beginning June 2001 and ending November 2002
Health Home Referrals(N=2525)Health Home Referrals(N=2525)
Percent of Referrals Leadingto Health Home VisitsPercent of Referrals Leadingto Health Home Visits
N=2116
N=262
N=1841
N=13
Percent of Enrollees Who WerePatients Prior to Enrollment
(N=185)
(N=126)
(N=742)
(N=1063)
(N=2116)
Time Between First Pre-CHAPVisit and CHAP EnrollmentTime Between First Pre-CHAPVisit and CHAP Enrollment
(N=1057)
(N=54)
(N=36)
(N=256)
(N=711)
SummaryReferrals and EnrollmentSummaryReferrals and Enrollment
lOver 2500 persons enrolled in CHAP in initial 16months
–Another 400-500 enrolled in Medicaid
lLargest providers LaRed and Westside Followed byVIP 2
lMost captured at health homes themselves; only 21percent at ED’s
l50-60 percent of those referred to health home makevisit
l30-40 percent referred to health home were alreadypatients there
SummaryChanges in Health Care UtilizationSummaryChanges in Health Care Utilization
lSubstantial increases in some preventivecare (Pap’s, mammograms, cholesterol)
lSmall impact on CRC screening and adultimmunizations
lSignificant reductions in ED visits, but nothospitalizations
lDramatic improvements in satisfaction withcare
CaveatsCaveats
lShort time frame: establishing medicalhome takes longer to accrue benefits
lNot able to capture all benefits; may haveless unnecessary care and fewer medicationerrors by shifting care from ED to primarycare
lMedical home is essential but not sufficientfor optimal care
lCRC screening may require additionalinterventions (e.g., education, payment)
Future DirectionsFuture Directions
lNew CHAP data collection tool
–Impact on efficiency and cost
lContinue to monitor Colorectal CancerScreening, PAPs and Mammograms
lEvaluate CHAP as part of overall uninsuredin DE
–Colorectal Cancer Screening
–Women’s Health
Demographics (N=795)
