Predictors of Reduced Nonurgent Emergency Department Use in a Low-Income Uninsured Population

2.50
Hdl Handle:
http://hdl.handle.net/10755/151598
Type:
Presentation
Title:
Predictors of Reduced Nonurgent Emergency Department Use in a Low-Income Uninsured Population
Abstract:
Predictors of Reduced Nonurgent Emergency Department Use in a Low-Income Uninsured Population
Conference Sponsor:Sigma Theta Tau International
Conference Year:2005
Author:Wetta-Hall, Ruth, RN, PhD, MPH, MSN
P.I. Institution Name:University of Kansas Medical School-Wichita
Title:Research Assistant Professor
Purpose: To identify predictors of reduced non-urgent emergency department (ED) use among low-income uninsured associated with a nursing/social work case management program. Intervention: Nurses and social workers collaborated to assist high utilizers of ED services to find a primary care medical home and access community resources. Methods: The voluntary, cross-sectional study sample included 459 low-income, uninsured adult residents of Sedgwick County, Kansas, enrolled between December 2001 through February 2004. Logistic regression was used to identify predictors of reduction in ED use among participants. Independent variables included age, gender, race, marital status, social support, education level, employment status and annual income. Case management process factors included number of days case was opened, number of contacts between client and team members, number of follow-up appointments, number and types of referrals. Dependent variable: Change in ED visits pre/post intervention. Results: Nearly 85 percent (n=388) of program participants reduced their ED use (mean reduction 2.3 visits/client). Participant characteristics and process factors that were significant predictors of reduction in non-urgent ED visits included: female gender (OR 1.85, CI 1.00-3.48, p < 0.05), verified medical referrals (OR 0.63, CI 0.42-0.94, p < 0.05), number of ED visits before intervention (OR 1.22, CI 1.03-1.43, p < 0.05), client case was opened less than 63 days (OR 2.81, CI 1.03-7.70, p < 0.05), and client case opened from 64-123 days (OR 2.96, CI 1.14-7.64, p < 0.05). Conclusions: Findings suggest those most responsive to the case management intervention may have less complex social needs or fewer health needs. In addition, more assertive case management may be required to reach those with more serious medical and social circumstances. Implications: CCM is a potential solution for low-income, uninsured populations to navigate and access the fragmented, American health care delivery system.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePredictors of Reduced Nonurgent Emergency Department Use in a Low-Income Uninsured Populationen_GB
dc.identifier.urihttp://hdl.handle.net/10755/151598-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Predictors of Reduced Nonurgent Emergency Department Use in a Low-Income Uninsured Population</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Wetta-Hall, Ruth, RN, PhD, MPH, MSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Kansas Medical School-Wichita</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Research Assistant Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">rwettaha@kumc.edu</td></tr><tr><td colspan="2" class="item-abstract">Purpose: To identify predictors of reduced non-urgent emergency department (ED) use among low-income uninsured associated with a nursing/social work case management program. Intervention: Nurses and social workers collaborated to assist high utilizers of ED services to find a primary care medical home and access community resources. Methods: The voluntary, cross-sectional study sample included 459 low-income, uninsured adult residents of Sedgwick County, Kansas, enrolled between December 2001 through February 2004. Logistic regression was used to identify predictors of reduction in ED use among participants. Independent variables included age, gender, race, marital status, social support, education level, employment status and annual income. Case management process factors included number of days case was opened, number of contacts between client and team members, number of follow-up appointments, number and types of referrals. Dependent variable: Change in ED visits pre/post intervention. Results: Nearly 85 percent (n=388) of program participants reduced their ED use (mean reduction 2.3 visits/client). Participant characteristics and process factors that were significant predictors of reduction in non-urgent ED visits included: female gender (OR 1.85, CI 1.00-3.48, p &lt; 0.05), verified medical referrals (OR 0.63, CI 0.42-0.94, p &lt; 0.05), number of ED visits before intervention (OR 1.22, CI 1.03-1.43, p &lt; 0.05), client case was opened less than 63 days (OR 2.81, CI 1.03-7.70, p &lt; 0.05), and client case opened from 64-123 days (OR 2.96, CI 1.14-7.64, p &lt; 0.05). Conclusions: Findings suggest those most responsive to the case management intervention may have less complex social needs or fewer health needs. In addition, more assertive case management may be required to reach those with more serious medical and social circumstances. Implications: CCM is a potential solution for low-income, uninsured populations to navigate and access the fragmented, American health care delivery system.</td></tr></table>en_GB
dc.date.available2011-10-26T11:07:30Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T11:07:30Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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