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Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care: A Cost-Benefit Analysis

An Evidence-Based Practice

Description

This study estimates what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program's expenses using a microsimulation of patient health care utilization, costs, and revenues. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources.

Goal / Mission

The goal of this study is to determine how many Community Health Workers (CHW) would be needed to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer's perspective.

Impact

This study adds significant knowledge to the existing literature on CHW programs, and particularly provides critical information to payers that can be used for making decisions on appropriate payment models

Results / Accomplishments

The level of reduction in ED visits and associated inpatient hospitalizations would vary substantially by the primary diagnosis for a patient. Achieving cost savings would require preventing 4 to 23 ED visits and associated hospitalizations per year among a panel of patients, representing a reduction of 3% to 21% in total ED visits. For example:
A CHW with a caseload of 70 asthma patients would need to prevent about 14 ED visits (15% of the total), of which 23% would be expected to result in a hospitalization.
A CHW with a caseload of 70 heart failure patients would need to prevent about 4 ED visits (3% of the total), of which over 90% would be expected to result in hospitalization.

About this Promising Practice

Topics
Health / Other Conditions
Health / Health Care Access & Quality
Community / Community & Business Resources
For more details
https://www.ncbi.nlm.nih.gov/pubmed/27547954

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An Evidence-Based Practice meets the following HCI criteria:

  1. The program description includes at a minimum: the sponsoring organization, program goals, program implementation steps, and outcomes that have demonstrated program success in achieving the program goal in one or more localities.
  2. The results from an evaluation of the program include quantitative measures showing improvement in the outcome(s) of interest after the implementation of the program (i.e. increase in smoking cessation, not just the delivery of a smoking cessation program). The outcome measure(s) is/are compared at relevant time periods before and after the intervention or program implementation. Alternatively, the evaluation study compares the outcome(s) between an intervention group and an appropriate control group.
  3. The study is of peer-review quality and presents numbers in a scientific manner; measurements of precision and reliability are included (e.g. confidence intervals, standard errors), results from statistical tests show a significant difference or change in the outcome measure(s), and relevant point estimates and p-values are presented. Note: if the results from an evaluation of a program are presented in a scientific manner and the outcome measure is improved compared to the baseline measurement or the control group but the difference is not statistically significant, the practice is classified as effective and not evidence-based.